title: Classifying distinct basal cell carcinoma subtype by means of dermatoscopy and reflectance confocal microscopy.
abstract: BACKGROUND
  The current guidelines for the management of basal cell carcinoma (BCC) suggest a different therapeutic approach according to histopathologic subtype. Although dermatoscopic and confocal criteria of BCC have been investigated, no specific studies were performed to evaluate the distinct reflectance confocal microscopy (RCM) aspects of BCC subtypes.
  
  
  OBJECTIVE
  To define the specific dermatoscopic and confocal criteria for delineating different BCC subtypes.
  
  
  METHODS
  Dermatoscopic and confocal images of histopathologically confirmed BCCs were retrospectively evaluated for the presence of predefined criteria. Frequencies of dermatoscopic and confocal parameters are provided. Univariate and adjusted odds ratios were calculated. Discriminant analyses were performed to define the independent confocal criteria for distinct BCC subtypes.
  
  
  RESULTS
  Eighty-eight BCCs were included. Dermatoscopically, superficial BCCs (n=44) were primarily typified by the presence of fine telangiectasia, multiple erosions, leaf-like structures, and revealed cords connected to the epidermis and epidermal streaming upon RCM. Nodular BCCs (n=22) featured the classic dermatoscopic features and well outlined large basaloid islands upon RCM. Infiltrative BCCs (n=22) featured structureless, shiny red areas, fine telangiectasia, and arborizing vessels on dermatoscopy and dark silhouettes upon RCM.
  
  
  CONCLUSIONS
  The retrospective design.
  
  
  CONCLUSIONS
  Dermatoscopy and confocal microscopy can reliably classify different BCC subtypes.
authors.affiliation: Dermatology and Skin Cancer Unit, Arcispedale S. Maria Nuova, IRCCS, Reggio Emilia, Italy. Electronic address: longo.caterina@gmail.com.
authors.forename: Caterina
authors.initials: C
authors.lastname: Longo
authors.affiliation: Dermatology and Skin Cancer Unit, Arcispedale S. Maria Nuova, IRCCS, Reggio Emilia, Italy.
authors.forename: Aimilios
authors.initials: A
authors.lastname: Lallas
authors.affiliation: Dermatology and Skin Cancer Unit, Arcispedale S. Maria Nuova, IRCCS, Reggio Emilia, Italy.
authors.forename: Athanassios
authors.initials: A
authors.lastname: Kyrgidis
authors.affiliation: Skin and Cancer Associates, Plantation, Florida.
authors.forename: Harold
authors.initials: H
authors.lastname: Rabinovitz
authors.affiliation: Dermatology and Skin Cancer Unit, Arcispedale S. Maria Nuova, IRCCS, Reggio Emilia, Italy.
authors.forename: Elvira
authors.initials: E
authors.lastname: Moscarella
authors.affiliation: Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Silvana
authors.initials: S
authors.lastname: Ciardo
authors.affiliation: Dermatology and Skin Cancer Unit, Arcispedale S. Maria Nuova, IRCCS, Reggio Emilia, Italy; Department of Dermatology, Medical University of Graz, Graz, Austria.
authors.forename: Iris
authors.initials: I
authors.lastname: Zalaudek
authors.affiliation: Skin and Cancer Associates, Plantation, Florida.
authors.forename: Margaret
authors.initials: M
authors.lastname: Oliviero
authors.affiliation: Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Amanda
authors.initials: A
authors.lastname: Losi
authors.affiliation: Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Salvador
authors.initials: S
authors.lastname: Gonzalez
authors.affiliation: Melanoma Institute Australia, The University of Sydney and Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: Pascale
authors.initials: P
authors.lastname: Guitera
authors.affiliation: Pathology Unit, Arcispedale S. Maria Nuova, IRCCS, Reggio Emilia, Italy.
authors.forename: Simonetta
authors.initials: S
authors.lastname: Piana
authors.affiliation: Dermatology and Skin Cancer Unit, Arcispedale S. Maria Nuova, IRCCS, Reggio Emilia, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Argenziano
authors.affiliation: Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pellacani
mesh_terms: D000328:Adult; D000368:Aged; D002280:Basal Cell Carcinoma / Q000145:classification* / Q000473:pathology* / Q000648:ultrastructure; D015331:Cohort Studies; D016001:Confidence Intervals; D046169:Dermoscopy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D015588:Observer Variation; D016017:Odds Ratio; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000145:classification* / Q000473:pathology* / Q000648:ultrastructure
keywords: basal cell carcinoma; dermatoscopy; dermoscopy; diagnosis; infiltrative basal cell carcinoma; nodular basal cell carcinoma; reflectance confocal microscopy; superficial basal cell carcinoma