Unusual dermoscopic patterns of basal cell carcinoma mimicking melanoma. Issue 6 (6th February 2022)

• Record Type: Journal Article
• Authors: Di Matteo, Eleonora; Pampena, Riccardo; Pizzichetta, Maria A.; Cinotti, Elisa; Chester, Johanna; Kaleci, Shaniko; Manfredini, Marco; Guida, Stefania; Dika, Emi; Moscarella, Elvira; Lallas, Aimilios; Apalla, Zoe; Argenziano, Giuseppe; Perrot, Jian L; Tognetti, Linda; Lai, Michela; Cantisani, Carmen; Roberti, Vincenzo; Fiorani, Diletta; Baraldi, Carlotta; Veneziano, Leonardo; Papageorgiou, Chryssoula; Ciardo, Silvana; Rubegni, Pietro; Zalaudek, Iris; Patrizi, Annalisa; Longo, Caterina; Bianchi, Luca; Pellacani, Giovanni; Farnetani, Francesca
• Is Part Of: Experimental dermatology. Volume 31:Issue 6(2022)
• Page Start: 890
• Page End: 898
• Publication Date: 2022-02-06
• Subjects: basal cell carcinoma -- dermoscopy -- malignant melanoma -- non‐invasive diagnosis -- non‐invasive techniques; Dermatology -- Periodicals; 616.5
• DOI: 10.1111/exd.14533
• Languages: English
• ISSNs: 0906-6705

Abstract

Abstract: Background: Basal cell carcinoma can simulate melanoma and specific dermoscopic criteria have not yet been defined in a large cohort. Objective: To identify dermoscopic "trump" characteristics for differential diagnosis, identify cluster groups and assess the clinical impact of this study's findings. Methods: Retrospective, multicentric comparative study of atypical, non‐facial basal cell carcinoma (≥1 seven‐point checklist criteria) and melanoma (with at least one BCC criteria) at dermoscopy. Observed dermoscopic features were used to develop a proposed score. Lesion clusters were defined with hierarchical analysis. Clinical impact was assessed with a blinded reader study following this study's results. Results: A total of 146 basal cell carcinoma and 76 melanoma were included. Atypical vascular pattern was common to most lesions (74.5%). Twelve trump features were included in the proposed score (sensitivity 94.1% and specificity 79.5%). Cluster analysis identified 3 basal cell carcinoma and 3 melanoma clusters. Findings improved overall diagnostic accuracy and confidence (26.8% and 13.8%, respectively; p < 0.001). Conclusions: These findings support the notion that atypical vascular pattern should be considered a shared feature of both melanoma and atypical basal cell carcinoma. Our proposed score improves diagnostic accuracy and confidence. Absence of pigmented features was associated with lower diagnostic accuracy and confidence.