Non-Melanoma Skin Cancers Coverage from Every Angle

Dermatoscopic Patterns in Non-Melanoma Skin Cancer

By: Noelle Cutter, PhD
Posted: Thursday, March 25, 2021

The incidence of non-melanoma skin cancer has been increasing worldwide. A recent report published in Dermatologic Therapy aimed to correlate dermatoscopic finding with the pathology of keratinocyte-derived tumors. Cengizhan Erdem, MD, of Ankara University, Zonguldak, Turkey, and colleagues report that using dermatopathologic and dermatoscopic features significantly may aid in the diagnosis of actinic keratosis, Bowen’s disease, keratoacanthoma, and squamous cell carcinoma. 

“Our results may contribute to the determination of the lesions to be biopsied in patients with multiple actinic keratosis on chronically sun-damaged skin,” shared the study authors.

A total of 242 histologically verified lesions from 169 patients diagnosed with actinic keratosis, Bowen’s disease, keratoacanthoma, or squamous cell carcinoma from May 2010 to April 2018 were included in the study. A retrospective evaluation was performed using dermatoscopy to correlate patterns with pathologic analysis.

Of the 242 lesions, 145 were flat (86 actinic keratosis, 30 Bowen’s disease, and 29 squamous cell carcinoma), and 97 were raised. Actinic keratosis lesions had surface scale in 78.8%, pigmentation in 53.5%, and erythema in 52.5%. Clinical, dermatoscopic features and dermatopathologic correlations of actinic keratosis and squamous cell carcinoma showed white circles on dermatoscopy and were characterized histologically by hyperkeratosis. Four-dot clod was observed in 27.7% of cases of actinic keratosis, 14.7% of cases of Bowen’s disease, and 16.1% of cases of squamous cell carcinoma. In actinic keratosis, four-dot-clods correlated to hyperkeratotic and parakeratotic corneal layers. White clods of keratin formed by neoplastic squamous cells correlated with squamous cell carcinoma.

Brown dots, circles, and structureless areas were hypermelanization in pigmented actinic keratosis. Gray circles correlated with isthmic pigmentation of follicular basal cells. Bowen’s disease lesions had brown structureless areas and linear arrangement of brown dots, which seemed to correlat with melanophages in dermal papillae. 

Disclosure: The authors reported no conflicts of interest.

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