a partly pigmented basal cell cancer

what's the diagnosis?

describe the dermoscopic appearance

 

This dermoscopic view of a basal cell cancer showcases some of the disorderly pigmented structures often seen in these tumours. They are variously described as cartwheel or spoke structures, ovoid nests, maple leaf structures, globules and a few other things in the books. But they are not manufactured goods off a production line, they are basically disorderly arrangements of melanin in and around BCC keratinocytes due to loss of mitotic control in the tumour, so all of these descriptive terms are just word sketches, helpful to a point but lacking precision. Pigmented structures in BCCs can be brown, grey or blue or mixtures of these colours. Describing these shapes and colours is not a precise science.

The vessels and pink background are also suggestive of a BCC and there are no specific structures like a reticular network to point to a melanoma, but you’d want an excision biopsy and histology without delay, as while this overall picture is very typical for a BCC, there is a grey area between pigmented BCC and melanoma. Dermoscopy with experience and tuition tends to resolve grey into black or white, I was sure this was a BCC and the histopathologist agreed.

NB these images are not perfectly focussed, that’s life. I’ll post some more and better ones later later. Just getting a feel for this blog.  Feel free to make any honest not for profit use of these consented and anonymous images.