title: Dermatoscopy of basal cell carcinoma: morphologic variability of global and local features and accuracy of diagnosis.
abstract: BACKGROUND
  Early detection of basal cell carcinoma (BCC) is crucial to reduce the morbidity of this tumor.
  
  
  OBJECTIVE
  We sought to investigate the variability and diagnostic significance of dermatoscopic features of BCCs.
  
  
  METHODS
  We conducted retrospective dermatoscopic analysis of 609 BCCs and 200 melanocytic and nonmelanocytic lesions, and assessment of interrater reliability of dermatoscopic BCC criteria.
  
  
  RESULTS
  Lesions included nonpigmented (15.1%), lightly pigmented (33.2%), pigmented (42.7%), and heavily pigmented (9%) BCCs. Classic BCC patterns including arborizing telangiectasia (57.1%), blue/gray ovoid nests (47.5%), ulceration (39.2%), multiple blue/gray globules (26.1%), leaflike areas (15.9%), and spoke-wheel areas (9%) were significantly increased in pigmented BCCs compared with nonpigmented and heavily pigmented BCCs (P = .0001). Among nonclassic BCC patterns, we detected short fine superficial telangiectasia (10%) and multiple small erosions (8.5%), and described two new patterns named "concentric structures" (7.6%) and "multiple in-focus blue/gray dots" (5.1%). Dermatoscopic features suggestive of melanocytic lesions (eg, multiple brown to black dots/globules, blue/white veillike structures, and nonarborizing vessels) were observed in 40.6% BCCs and significantly increased in heavily pigmented BCCs (P < .0001). Expert observers provided an accurate (sensitivity: 97%) and reliable (K: 87%) dermatoscopic diagnosis of BCC, although a significant difference in terms of specificity (P = .0002) and positive predictive value (P = .0004) was found. Arborizing telangiectasia, leaflike areas, and large blue/gray ovoid nests represented reliable and robust diagnostic parameters.
  
  
  CONCLUSIONS
  The study was retrospective.
  
  
  CONCLUSIONS
  BCCs show a large spectrum of global and local dermatoscopic features; heavily pigmented BCCs show the most challenging combinations of dermatoscopic features.
authors.affiliation: Department of Dermatology, University of L'Aquila, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Altamura
authors.affiliation: Sydney Melanoma Diagnostic Center, Sydney Cancer Center, Royal Prince Alfred Hospital, Camperdown, and Discipline of Dermatology, University of Sydney, Sydney, Australia.
authors.forename: Scott W
authors.initials: SW
authors.lastname: Menzies
authors.affiliation: Department of Dermatology, Second University of Naples, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Argenziano
authors.affiliation: Department of Dermatology, Medical University of Graz, Graz, Austria.
authors.forename: Iris
authors.initials: I
authors.lastname: Zalaudek
authors.affiliation: Dermatology Research Center, The University of Queensland, School of Medicine, Princess Alexandra Hospital, Brisbane, Australia.
authors.forename: H Peter
authors.initials: HP
authors.lastname: Soyer
authors.affiliation: Molecular and Nutritional Epidemiology Unit, Cancer Prevention and Research Institute, Florence, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Sera
authors.affiliation: Sydney Melanoma Diagnostic Center, Sydney Cancer Center, Royal Prince Alfred Hospital, Camperdown, and Discipline of Dermatology, University of Sydney, Sydney, Australia.
authors.forename: Michelle
authors.initials: M
authors.lastname: Avramidis
authors.affiliation: Dermatology Research Center, The University of Queensland, School of Medicine, Princess Alexandra Hospital, Brisbane, Australia.
authors.forename: Kathryn
authors.initials: K
authors.lastname: DeAmbrosis
authors.affiliation: Department of Dermatology, University of L'Aquila, Italy.
authors.forename: Maria Concetta
authors.initials: MC
authors.lastname: Fargnoli
authors.affiliation: Department of Dermatology, University of L'Aquila, Italy. Electronic address: ketty.peris@univaq.it.
authors.forename: Ketty
authors.initials: K
authors.lastname: Peris
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002280:Basal Cell Carcinoma / Q000175:diagnosis* / Q000473:pathology; D046169:Dermoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000473:pathology; D055815:Young Adult