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Dermatoscopy aids in the diagnosis of the solitary red scaly patch or plaque–features distinguishing superficial basal cell carcinoma, intraepidermal carcinoma, and psoriasis

https://doi.org/10.1016/j.jaad.2008.05.013Get rights and content

Background

Intraepidermal carcinoma (IEC), superficial basal cell carcinoma (sBCC), and psoriasis are common entities that may all present as well-defined, brightly erythematous plaques. Currently, there are limited data on the dermatoscopic features that differentiate these diagnoses.

Objective

We sought to describe the most significant morphologic findings seen on dermatoscopy of IEC, sBCC, and psoriasis, and formulate a diagnostic model based on these features.

Method

We conducted a retrospective observational study using macrophotography and dermatoscopy to evaluate the presence or absence of dermatoscopic features and formulated diagnostic models for each diagnosis. A convenient sample of 300 lesions was collected from 255 patients from two hospital dermatology clinics and 4 private dermatology practices. These comprised 150 cases of sBCC, 100 cases of psoriasis, and 50 cases of IEC.

Results

The most significant dermatoscopic features of IEC were a clustered vascular pattern, glomerular vessels, and hyperkeratosis. When all 3 features were observed together, the diagnostic probability for IEC was 98%. sBCCs were characterized by a scattered vascular pattern, arborizing microvessels, telangiectatic or atypical vessels, milky-pink background, and brown dots/globules; the diagnostic probability was 99% if 4 of these 6 features were identified. For psoriasis, the significant features identified were a homogenous vascular pattern, red dots, and light-red background, yielding a diagnostic probability of 99% if all 3 features were present.

Limitations

Lack of evaluation of interobserver/intraobserver reproducibility is a limitation.

Conclusion

Dermatoscopy is valuable in the diagnosis and differentiation of IEC, sBCC, and psoriasis because of consistent dermatoscopic morphology.

Section snippets

Methods

Our study was conducted during an 8-month period from February to October 2005. Approval was obtained from our ethics committees.

Digital dermatoscopic images of the lesions were obtained by using a dermatoscope (Heine Delta 20, Heine, Herrsching, Germany) (10-fold magnification) mounted on a digital camera (Coolpix 4500, Nikon, Tokyo, Japan) (4.0 megapixels, 4× zoom) at our dermatology clinics and several private dermatology practices (J. W. K., A. J. C., M. H., A. H. C.) in Melbourne,

Results

In total, 32 dermatoscopic features were scored for each lesion (Table II and Fig 1). For IEC (Table III), the global pattern that best described the distribution of vessels was “clustered.” Other statistically significant features of IEC included glomerular vessels, lacunar vessels, hyperkeratosis, and hairpin vessels. The most significant criteria as determined by multivariate analysis for the diagnosis of IEC were a clustered global vascular pattern, glomerular vessels, and hyperkeratosis (

Discussion

Dermatologists are confronted every day with red, scaly patches or plaques for diagnosis. Particularly when lesions are isolated or few in numbers the differential diagnosis can be challenging and a biopsy may be necessary. Dermatoscopy is a valuable in vivo diagnostic aid that helps direct therapy.

Each of the 3 entities studied was most usefully distinguished by vascular features. For IEC, glomerular vessels have been described as the key dermatoscopic criterion for the diagnosis.4, 5, 6, 7

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Funding sources: None.

Conflicts of interest: None declared.

Presented at the 39th Annual Scientific Meeting, Australasian College of Dermatologists, Melbourne, Victoria, May 14-17, 2006, and First Congress of the International Dermoscopy Society, Naples, Italy, April 27-29, 2006.

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Copyright © 2008 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.