Dermoscopic criteria and basal cell carcinoma

Basal cell carcinoma (BCC) is the most frequent of all skin cancers in the white population. Dermoscopy is a method that improves diagnosis in pigmented and non-pigmented skin lesions, allowing early diagnosis, especially of incipient lesions. The classical dermoscopy algorithm for the diagnosis of BCC includes lack of pigment network and the presence of at least one of the following criteria: ulceration, maple-leaf like structure, blue-gray globules, blue-ovoid nests, arborizing vessels and spoke-wheel structures. The non-classical dermoscopic features of BCC include some criteria more frequently seen in superficial BCC such as pink-white areas, concentric structures, multiple erosions, multiple in-focus blue-gray dots and fine vessels. Recently, the dermoscopy of Fibroepithelioma of Pinkus has also been described with the presence of fine arborizing vessels, white streaks and gray-brown structureless areas. Some dermoscopic structures also present in BCC are just visible with polarized dermoscopy such as white shiny streaks or Chrysalides and Rosetas. Improved knowledge of all these criteria may avoid some diagnostic pitfalls and improve the early recognition of BCCs.