Role of Dermoscopy in the Assessment of Basal Cell Carcinoma

Basal cell carcinoma is one of the most common cancers in white people, with a continuous increase worldwide. Dermoscopy, a non-invasive technique, allows early diagnosis based on the presence of typical vascular structures, pigmented structures, and ulceration and the absence of specific melanocytic structures. Moreover, dermoscopy is useful in basal cell carcinoma management, enabling the differentiation between multiple histological subtypes, between pigmented and non-pigmented variants and allowing a more accurate assessment of surgical margins. After non-ablative therapies, dermoscopy allows the accurate detection of residual disease. The purpose of this review is to highlight the dermoscopic features encountered in basal cell carcinoma and to outline the role of dermoscopy for diagnosis and therapeutic response in this cancer.

Clinical and dermoscopic features of Fibroepithelioma of Pinkus: case series with an emphasis on hypopigmented to pink lines intersecting at acute angles

Fibroepithelioma of Pinkus (FEP) is a subtype of basal cell carcinoma (BCC) that can clinically resemble intradermal nevi (IDN) and fibromas. We performed a retrospective review of consecutively biopsied lesions confirmed to be FEP on histopathology diagnosed from January 1, 2008 to April 8, 2019. Clinical (n = 48), contact non-polarized dermoscopy (NPD) (n = 44), and contact polarized dermoscopy (PD) (n = 22) images from 36 patients were reviewed. Mean age was 64.5 years (SD 15.1 years, range 24-86 years) at diagnosis of first FEP lesion. Most lesions were located on the torso (n = 28, 58.3%), followed by the lower extremity (n = 9, 18.8%). The most common differential diagnoses at the time of biopsy included BCC (n = 40) and nevus (other than IDN, n = 5). Clinically, FEP were pink (95.8%), scaly (66.7%) papules (77.1%) displaying disrupted skin markings (62.5%) and absence of hair follicles (87.5%). NPD revealed serpentine (97.7%), dotted (81.8%), or polymorphous vessels (86.4%), and hypopigmented to pink lines intersecting at acute angles (HPLA) (52.3%). PD demonstrated serpentine (95.5%), dotted (86.4%), or polymorphous vessels (81.8%), shiny white lines (50.0%), and HPLA (59.1%). Classic features of BCC such as arborizing vessels (n = 2), ulceration (n = 1), shiny white blotches and strands (n = 1), blue-gray ovoid nest (n = 1), and leaf-like areas (n = 1) were uncommon. FEP often presents as scaly, erythematous papules with disrupted skin markings and absence of hair follicles. Dermoscopy reveals polymorphous vessels with shiny white lines and HPLA.

Novel Presentation of Fibroepithelioma of Pinkus on the Ear of a Patient Treated on a Panamanian Humanitarian Mission

Fibroepithelioma of Pinkus (FEP) is traditionally classified as an unusual variant of basal cell carcinoma. It has non-specific clinical findings yet distinct histologic features. The diagnosis can be challenging for clinicians because it often mimics benign entities such as intradermal nevi. FEP typically occurs on the trunk, but many body sites can be involved including the head, neck, and genitalia. According to a PubMed search of articles indexed in MEDLINE using "Fibroepithelioma of Pinkus" and "ear" or "auricle," there are no reports of FEP specifically occurring on the ear. We describe the first case of FEP on the ear of a heavily sun-damaged male treated while on a military humanitarian mission to Panama. This case helps support the classification of FEP as a basal cell carcinoma variant and raises awareness for this entity as it may be encountered both on military humanitarian missions and in military clinics.

Fibroepithelioma of Pinkus (FeP) Located in the Left Lower Quadrant of the Abdomen - Case Report and Review of the Literature

BACKGROUND

Fibroepithelioma of Pinkus (FeP) is an uncommon and controversial skin lesion, sharing features of both basal cell carcinoma (BCC) and trichoepithelioma. In this article, we present a case of FeP and synthesise current concepts on the etiopathogenesis, diagnosis and treatment of this uncommon tumour.

CASE REPORT

We report the case of an 88-year-old male patient presenting to the dermatology clinic for a sharply demarcated, pink, exophytic cutaneous tumour situated in the left inguinal region. The histopathological examination performed after complete surgical excision of the lesion revealed a diagnosis of FeP. A systematic review of the literature was conducted. The terms `fibroepithelioma` and `Pinkus` have been searched in bibliographical databases, including PubMed and Google Scholar, without time limitation up to February 15th, 2017. Seventy-nine articles that fulfilled all the required conditions were identified. Relevant citations and additional articles identified from references have been assessed. The systematic review included a total number of 452 cases of FeP.

CONCLUSION

Even though FeP is considered a relatively rare tumour, its true incidence rate might be higher than previously believed. The clinical aspects of the lesion described in this paper and its location in the left lower quadrant of the abdomen are classic features of FeP. Histopathologic examination revealed features of both BCC and trichoepithelioma. Further epidemiological studies are required to clarify whether patients with FEP should be screened for the occurrence of other malignancies.

Fibroepithelioma of Pinkus Revisited

Background

Fibroepithelioma of Pinkus (FeP) is considered a variant of basal cell carcinoma (BCC); however, in the past 20 years, some researchers have argued for its classification as a trichoblastoma. Recently, use of a new immunostaining marker and further dermoscopic characterization of FeP have advanced the debate about its proper classification.

Purpose

A review of the evidence for and against classification of FeP as BCC or trichoblastoma is presented.

Methods

Using PubMed, the term FeP was searched and relevant citations were assessed. Additional relevant articles were identified from references of key papers.

Results

FeP shares characteristics of both trichoblastoma and BCC.

Conclusion

Derived from the same cell type, BCC and trichoblastoma may be best considered as representing opposite ends of a spectrum of differentiation, with FeP deserving an intermediate classification.

Two adjacent individual fibroepithelioma of Pinkus of the umbilicus-one pink, one pigmented-a case report and review of the literature

We present a unique case of separate and independent adjacent fibroepitheliomas of Pinkus (FeP) arising from the umbilicus in an 83-year-old man. Of further interest, one is pigmented and the other nonpigmented. Clinical, dermatoscopic and histopathological images are provided.

A review of the published literature is undertaken to attempt to assess the incidence of pigmented versus nonpigmented FeP. Of 24 published FeP cases, 10 (41.7%) have been pigmented. Thus to date pigmented FeP comprise approaching one-half of all reported cases.

Dermoscopy in the diagnosis and management of basal cell carcinoma

The dermoscopic findings of basal cell carcinoma (BCC) were first described more than a decade ago and the list of BCC-related criteria has been several times updated and enriched. Today, the dermatoscope is considered the key tool for the diagnosis of BCC, since it allows its early detection and enables its discrimination from other pigmented and nonpigmented skin tumors. The dermoscopic pattern of BCC results from several combinations of well-known BCC criteria, depending on several factors, including histopathologic subtype, location, gender, age and pigmentary trait. In addition, recent evidence highlighted that dermoscopy is also useful in the management of BCC, since it provides information on the tumor subtype, the presence of pigmentation or ulceration and the response to nonablative treatments.

The dermatoscopic universe of basal cell carcinoma

Following the first descriptions of the dermatoscopic pattern of basal cell carcinoma (BCC) that go back to the very early years of dermatoscopy, the list of dermatoscopic criteria associated with BCC has been several times updated and renewed. Up to date, dermatoscopy has been shown to enhance BCC detection, by facilitating its discrimination from other skin tumors and inflammatory skin diseases. Furthermore, upcoming evidence suggests that the method is also useful for the management of the tumor, since it provides valuable information about the histopathologic subtype, the presence of clinically undetectable pigmentation, the expansion of the tumor beyond clinically visible margins and the response to non-ablative treatments. In the current article, we provide a summary of the traditional and latest knowledge on the value of dermatoscopy for the diagnosis and management of BCC.