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Álvarez-Salafranca M, Gómez-Martín I, Bañuls J, Serrano P, Medina C, Llambrich A, Pizarro Á, Ara M, Zaballos P. Dermoscopy of inflamed seborrheic keratosis: A great mimic of malignancy. Australas J Dermatol 2021; 63:53-61. [PMID: 34958128 DOI: 10.1111/ajd.13781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/17/2021] [Accepted: 12/12/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Clinical and dermoscopic recognition of seborrheic keratoses (SKs) is often straightforward, and biopsy might not be required. However, inflamed SKs (iSKs) can pose a diagnostic challenge. Dermoscopic features of iSKs have not yet been evaluated to date. OBJECTIVES To assess the diagnostic ability of a group of dermatologists to diagnose iSKs by dermoscopy. To evaluate the dermoscopic findings of a long series of inflamed seborrheic keratoses. METHODS Clinical and dermoscopic images of 100 difficult-to-diagnose skin tumours, including 29 iSKs, were presented to 33 clinicians (24 dermatologists and 9 dermatology residents), who were blinded to the diagnosis. The dermoscopic features of a series of 219 iSKs were retrospectively analysed. RESULTS iSKs were correctly identified in a 37.6% of cases. Classic dermoscopic criteria were present in only 47% of iSKs. The most frequent dermoscopic feature in iSKs was the presence of vascularization (91.3%), but only a 44.5% showed predominance of hairpin vessels. A bluish hue was observed in 18.3% of lesions. Seven dermoscopic patterns were identified, based on the dermoscopic similarity to other tumours: seborrheic keratosis-like (28.8%); squamous cell carcinoma-like (25.6%); melanoma-like (17.8%); keratoacanthoma-like (6.8%); basal cell carcinoma-like (5.9%); verruca vulgaris-like (5.9%); nevus-like (2.3%). CONCLUSIONS The diagnosis of iSKs can be challenging even with dermoscopy. They may behave as authentic mimics of other cutaneous tumours, including squamous cell carcinoma or melanoma. For this reason, histopathological examination should be mandatory in these cases.
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Affiliation(s)
| | | | - José Bañuls
- Department of Dermatology, Hospital General Universitario de Alicante, ISABIAL, Alicante, Spain
| | - Patricia Serrano
- Department of Dermatology, Consorci Sanitari del Maresme, Barcelona, Spain
| | - Carolina Medina
- Department of Dermatology, Hospital Universitario de Gran Canaria 'Doctor Negrín', Gran Canaria, Spain
| | - Alex Llambrich
- Department of Dermatology, Hospital de son Llatzer, Palma de Mallorca, Spain
| | - Ángel Pizarro
- Department of Dermatology, Clínica Dermatológica Internacional, Madrid, Spain
| | - Mariano Ara
- Department of Dermatology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Pedro Zaballos
- Department of Dermatology, Hospital de Sant Pau i Santa Tecla, Tarragona, Spain
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Niculet E, Craescu M, Rebegea L, Bobeica C, Nastase F, Lupasteanu G, Stan DJ, Chioncel V, Anghel L, Lungu M, Tatu AL. Basal cell carcinoma: Comprehensive clinical and histopathological aspects, novel imaging tools and therapeutic approaches (Review). Exp Ther Med 2021; 23:60. [PMID: 34917186 PMCID: PMC8630439 DOI: 10.3892/etm.2021.10982] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/06/2021] [Indexed: 12/13/2022] Open
Abstract
Basal cell carcinoma (BCC) is one of the most common malignant tumors worldwide, involving the skin. It is also part of keratinocyte carcinomas, alongside its squamous counterpart. It has low mortality and extremely low metastatic rates (although when present, it indicates a poor patient prognosis); it also has a high morbidity rate through local destruction and recurrence, particularly when perineural invasion is observed, clinically or histopathologically. BCC development is the result of environmental and patient factors, with genetics and ultraviolet radiation playing major roles. The clinical and histopathological aspects vary according to tumor subtype, being classified as high-risk tumors (nodular, superficial, pigmented and infundibulocystic BCC with adnexal differentiation) and fibroepithelial subtypes, or as high-risk tumors (micronodular, infiltrating, sclerosing/morphoeic and basosquamous subtype or the type with sarcomatoid differentiation). Dermoscopy is now complimented by novel in vivo diagnostic tools (optical coherence tomography, reflectance confocal microscopy, high-resolution ultrasonography, Raman spectroscopy or terahertz pulse imaging), improving the diagnostic accuracy and providing tumor depth and lateral margins without the use of invasive techniques. Novel treatment approaches for the treatment of BCC have recently been investigated with the use of hedgehog pathway inhibitors, such as Vismodegib. These approaches aim for complete resolution, minimal side-effects, high patient satisfaction with the optimal cosmetic results, particularly in key areas, such as the face. The present review article summarizes and discusses the comprehensive clinical and histopathological aspects of BCC, and presents novel imaging tools and therapeutic approaches that have been identified.
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Affiliation(s)
- Elena Niculet
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800010 Galați, Romania.,Department of Pathology, 'Sfantul Apostol Andrei' Emergency Clinical Hospital, 800578 Galați, Romania
| | - Mihaela Craescu
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800010 Galați, Romania.,Department of Clinical Radiotherapy, 'Sfantul Apostol Andrei' Emergency Clinical Hospital, 800578 Galați, Romania
| | - Laura Rebegea
- Department of Clinical Radiotherapy, 'Sfantul Apostol Andrei' Emergency Clinical Hospital, 800578 Galați, Romania.,Department of Neuropsychomotor Rehabilitation, 'Sf. Ioan' Clinical Hospital for Children, 800487 Galați, Romania
| | - Carmen Bobeica
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800010 Galați, Romania
| | - Florentina Nastase
- Department of Neuropsychomotor Rehabilitation, 'Sf. Ioan' Clinical Hospital for Children, 800487 Galați, Romania
| | - Gabriela Lupasteanu
- Department of Infectious Diseases, 'Sf. Cuvioasa Parascheva' Clinical Hospital of Infectious Diseases, 800179 Galați, Romania.,Medical Doctoral School, 'Ovidius' University, 900573 Constanta, Romania
| | - Daniela Jicman Stan
- Department of Otorhinolaryngology, 'Sfantul Apostol Andrei' Emergency Clinical Hospital, 800578 Galați, Romania.,Biomedical Doctoral School, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University of Galați, 800010 Galați, Romania
| | - Valentin Chioncel
- Department of Cardio-Thoracic Pathology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Clinical Cardiology, 'Bagdasar Arseni' Emergency Hospital, 041915 Bucharest, Romania
| | - Lucretia Anghel
- Department of Clinical Medicine, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800010 Galați, Romania
| | - Mihaela Lungu
- Department of Clinical Medicine, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800010 Galați, Romania
| | - Alin Laurentiu Tatu
- Department of Clinical Medicine, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800010 Galați, Romania.,Department of Dermatology, 'Sfanta Cuvioasa Parascheva' Clinical Hospital of Infectious Diseases, 800179 Galați, Romania.,Research Center in the Field of Medical and Pharmaceutical Sciences, ReFORM-UDJ, 'Dunărea de Jos' University, 800010 Galați, Romania.,Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR (Centrul Integrat Multidisciplinar de Cercetare de Interfata Dermatologica - CIM-CID), 'Dunărea de Jos' University, 800010 Galați, Romania
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