title: Vascular Patterns in Cutaneous Ulcerated Basal Cell Carcinoma: A Retrospective Blinded Study Including Dermoscopy.
abstract: The aim of this retrospective study was to determine the type and prevalence of vascular patterns in the ulcerated and non-ulcerated portions of histologically proven basal cell carcinomas (BCCs) and correlate them with other dermoscopic and clinical features, including the clinically supposed diagnosis. Three authors retrospectively collected 156 clinical and 156 dermoscopic digital images of ulcerated BCCs (histologically confirmed); each image was blindly evaluated by 2 other authors, who did not know the histological diagnosis. Seventeen lesions were completely ulcerated, while 139 lesions presented ulcerated and non-ulcerated portions. Correct clinical diagnosis was associated with the type of lesion, in particular 90.6% of partially ulcerated lesions were correctly diagnosed with clinical-dermoscopic examination, compared with 11.8% of totally ulcerated lesions (χ2 = 64.00, p = 0.000). Presence of arborizing pattern in the ulcerated portion was associated with a correct diagnosis (Fisher's exact test, p = 0.015). Correct diagnosis was also associated with absence of dotted pattern in the non-ulcerated area (χ2 = 16.18, p = 0.000); the absence of hairpin (χ2 = 6.08, p = 0.000) and glomerular patterns were associated with correct diagnosis in the ulcerated areas (χ2 = 18.64, p = 0.000). In case of completely ulcerated BCC the clinician lacks the means to correctly identify the correct nature of the lesion, and is driven towards an incorrect diagnostic conclusion.
authors.affiliation: Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, 11, Piazza Giulio Cesare, Bari, IT-70124 Bari, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Arpaia
authors.forename: Angela
authors.initials: A
authors.lastname: Filoni
authors.forename: Domenico
authors.initials: D
authors.lastname: Bonamonte
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Giudice
authors.forename: Margherita
authors.initials: M
authors.lastname: Fanelli
authors.forename: Michelangelo
authors.initials: M
authors.lastname: Vestita
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001808:Blood Vessels / Q000473:pathology*; D002280:Basal Cell Carcinoma / Q000098:blood supply* / Q000473:pathology; D016009:Chi-Square Distribution; D046169:Dermoscopy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000098:blood supply* / Q000473:pathology; D012883:Skin Ulcer / Q000473:pathology*