title: Dermal changes in superficial basal cell carcinoma, melanoma in situ and actinic keratosis and their implications.
abstract: BACKGROUND
  Basal cell carcinoma (BCC) has a characteristic stroma, but less is known about the dermal characteristics associated with melanoma in situ (MIS) and actinic keratosis (AK).
  
  
  METHODS
  Dermal changes were studied in 301 specimens of AK, BCC and MIS. Subsequently, blinded images of dermal changes from 90 randomly selected cases of those entities were used to assess the predictive value of the dermal changes. Agreement with the final diagnosis was calculated using kappa coefficient (κ).
  
  
  RESULTS
  Fibromyxoid stroma was present in 82% of BCC cases; fibrous stroma was seen in 25% of BCC, 58% of MIS and 35.6% of AK specimens (p < 0.05). A lichenoid inflammatory infiltrate was frequently associated with AK and a perifollicular infiltrate with periadnexal fibrosis with MIS. Blinded evaluation of images of the dermal changes associated with the tumors yielded the correct diagnosis in (54.4, 41.1 and 27.8%; average 41.2%) by the three appraisers. Coefficient of agreement in blinded imaged evaluation with the actual diagnosis was higher in the BCC and MIS compared with AK (κ = 0.37, p = 0.0001; κ = 0.2, p = 0.0005 and κ = -0.06, p = 0.84, respectively).
  
  
  CONCLUSIONS
  Dermal features may be helpful in predicting the correct diagnosis when tumor is not visible.
authors.affiliation: Ackerman Academy of Dermatopathology, New York, NY, USA.
authors.forename: Viktoryia
authors.initials: V
authors.lastname: Kazlouskaya
authors.forename: Saurabh
authors.initials: S
authors.lastname: Malhotra
authors.forename: Raquel
authors.initials: R
authors.lastname: Navarro
authors.forename: Karen Nguyen
authors.initials: KN
authors.lastname: Wu
authors.forename: Marianna
authors.initials: M
authors.lastname: Shvartsbeyn
authors.forename: Chen
authors.initials: C
authors.lastname: Shengli
authors.forename: Jiang
authors.initials: J
authors.lastname: Gui
authors.forename: Dirk M
authors.initials: DM
authors.lastname: Elston
mesh_terms: D002280:Basal Cell Carcinoma / Q000473:pathology*; D020405:Dermis / Q000473:pathology*; D005260:Female; D006801:Humans; D055623:Keratosis, Actinic / Q000473:pathology*; D008297:Male; D008545:Melanoma / Q000473:pathology*; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology*
keywords: cancer; malignant melanoma; non-melanoma skin cancer; pathology; pathology dermatopathology