title: Usefulness of Dermatoscopy for the Preoperative Assessment of the Histopathologic Aggressiveness of Basal Cell Carcinoma.
abstract: BACKGROUND
  Limited information is available regarding dermatoscopic differences between non-aggressive and aggressive types of basal cell carcinoma (BCC).
  
  
  OBJECTIVE
  To investigate dermatoscopic differences between non-aggressive and aggressive types.
  
  
  METHODS
  We evaluated 145 histopathologically confirmed BCCs from 141 patients. Histopathologic types and aggressiveness from 4 mm punch biopsy and their dermatoscopic findings were evaluated. We assessed the statistical significance of dermatoscopic differences between non-aggressive and aggressive types. To objectively predict aggressiveness, we created a "dermatoscopic index of BCC aggressiveness" in which 1 point was added and subtracted for each dermatoscopic finding significantly higher in aggressive and non-aggressive types, respectively.
  
  
  RESULTS
  Large blue-gray ovoid nests were found more frequently in non-aggressive type than aggressive one (85/105 [80.9%] vs. 21/40 [52.5%], p=0.001). Compared to non-aggressive type, aggressive type had more multiple blue-gray globules (29/40 [72.5%] vs. 57/105 [54.3%], p=0.046), arborizing telangiectasia (29/40 [72.5%] vs. 48/105 [45.7%], p=0.004), and concentric structure (11/40 [27.5%] vs. 12/105 [11.4%], p=0.018). Regarding dermatoscopic index, cases of aggressive type with a score of 1 were most common (n=18, 45.0%), followed by a score of 2 (n=14, 35.0%). Limited number of aggressive type of BCCs and the effect of width on the determination of histopathologic aggressiveness.
  
  
  CONCLUSIONS
  Aggressive type BCCs more often exhibited multiple blue-gray globules, arborizing telangiectasia, and concentric structure, while the non-aggressive type exhibited large blue-gray ovoid nests more frequently. Score exceeding 2 on the dermoscopic index can be screening criteria for aggressiveness. These dermatoscopic features and dermoscopic index could be useful for assessing aggressiveness of BCCs before surgery.
authors.affiliation: Department of Dermatology, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Hoon-Soo
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Department of Dermatology, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Jung-Min
authors.initials: JM
authors.lastname: Park
authors.affiliation: Department of Dermatology, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Je-Ho
authors.initials: JH
authors.lastname: Mun
authors.affiliation: Department of Dermatology, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Margaret
authors.initials: M
authors.lastname: Song
authors.affiliation: Department of Dermatology, Pusan National University School of Medicine, Busan, Korea. ; Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
authors.forename: Hyun-Chang
authors.initials: HC
authors.lastname: Ko
authors.affiliation: Department of Dermatology, Pusan National University School of Medicine, Busan, Korea. ; Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
authors.forename: Byung-Soo
authors.initials: BS
authors.lastname: Kim
authors.affiliation: Department of Dermatology, Pusan National University School of Medicine, Busan, Korea. ; Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
authors.forename: Moon-Bum
authors.initials: MB
authors.lastname: Kim
keywords: Basal cell carcinoma; Dermatoscopy; Histopathologic aggressiveness