The Primary Evaluation Of The Application Of Dermoscopy In Differential Diagnosis Of Some Nonmelanocytic Skin Cancers

Background:Besides its relevance for evaluating pigmented structures,dermoscopy enables the recognition of vascular structures and other subtle features that usually are less visible to the naked eye.Consequently,in the last years dermoscopy has been employed also for the evaluation of nonpigmented skin disorders,such as nonpigmented skin tumors,and inflammatory and infectious diseases,even for monitoring skin reactions to various treatments.Seborrheic Keratosis,Acticic Keratosis,Bowen Disease and Basal Cell Carcinoma are four clinically frequent non-melanocytic skin cancers.It's difficult to diagnosis by clinical appearance and they are different in harm and treatment.Objective:To describe the dermoscopic features in a series of Seborrheic Keratosis,Acticic Keratosis,Bowen Disease and Basal Cell Carcinoma and evaluate the application of this technique in some nonmelanocytic skin cancers.Methods:Dermoscopic images of histopathologically proven Seborrheic Keratosis(27 patients),Acticic Keratosis(21 patients),Bowen Disease(9 patients) and Basal Cell Carcinoma(30 patients) were evaluated for the presence of various dermoscopic features. Each lesion was photographed using the DermLite FOT0(3Gen)at 8-fold magnification, which was combined with the digital camera(KONICA MINOLTA,Tokyo Japan).Results:The majority of cases of Seborrheic Keratosis revealed a peculiar dermoscopic pattern characterized by pseudofollicular openings(89%) and horn pseudocysts(85%). Additional dermoscopic criteria in Seborrheic Keratosis include gyri and sulci(33%), scale(93%),fine hairpin vascular(15%) etc.In our study we observed,in the vast majority (95%) of facial nonpigmented Aks(20 lesions),repetitive dermoscopic features of 'strawberry' pattern,produced by a background erythema that,surrounding follicles with whitish halos(95%) or a whitish-yellowish 'targetoid' appearance(65%),resembled the surface of a strawberry;scale could also be seen(90%).Dermoscopic characteristics of pigmented AK(6 lesions) on the face include multiple slategray to dark-brown dots and globules around the follicular ostia(3 lesions),the annular-granular pattern(2lesions) and brown to gray pseudonetwork(3 lesions).The majority of cases of Bowen Disease revealed a peculiar dermoscopic pattern characterized by a scaly surface(100%) and glomerular vessels(67%).In addition,small brown dots regularly packed in a patchy distribution (56%),and structureless white areas(100%) were observed.On dermoscopy,23 cases of Basal Cell Carcinoma revealed peculiar vascular patterns:7 cases had arborized vessels in addition to short,fine telangiectasias;4 cases had arborized vessels without short,fine telangiectasias;12 cases had short,fine telangiectasias without arborized vessels.In addition,shiny white to red appearance(90%),gray-blue globules or gray-blue areas(53%), ulcerations(63%) and slate gray accumulations of pigment(40%) were observed.Conclusions:Dermoscopy can improve the diagnostic accuracy of Seborrheic Keratosis,Acticic Keratosis,Bowen Disease and Basal Cell Carcinoma because of the presence of repetitive morphological findings,thus can be helpful in the differential diagnosis of nonmelanocytic skin cancers.A limitation of our study is that we did not assess the specificity of the described dermoscopic criteria,in differentiating from other nonmelanocytic skin cancers and further study is needed to assess the specificity and sensitivity of these criteria.Furthermore,dermoscopy cannot succeed over the clinical information including the patients' history,clinical features,or typical laboratory, radiographic and cannot substitute the established histopathologic diagnosis to perform diagnosis.