PMC9838765_01
Clinical, dermoscopic, reflectance confocal microscopy (RCM), and histologic characteristics of a 0.9 mm pigmented basal cell carcinoma. Panel A shows the left forehead location (annotated by a black arrow). Panel B indicates the dermoscopic presence of blue-grey dots and blue-grey ovoid nests as well as an absence of a pigment network. Panel C showcases RCM features of tumor islands (indicated by red stars) encompassed by palisading nuclei (yellow arrow) and clefting (red arrow). Panel D presents the lesion's pathology slide (8X), with tumor islands in the dermis containing aggregates of basaloid cells (red stars), peripheral palisading nuclei (yellow arrow), and the presence of clefting
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Physical examination revealed a 0.9 mm light brown, asymmetric papule on the left forehead (Figure 1A). The lesion was further evaluated with a dermatoscope and digital images were taken, illustrating what appeared as blue-grey dots and blue-grey ovoid nests. (Figure 1B). Tumor islands, palisading of nuclei, and clefting were present, determining the diagnosis of BCC (Figure 1C). Dermatopathology reported microscopic findings of nodular aggregates of cells within the dermis, with many of the cells containing hyperchromatic nuclei, scant cytoplasm, and palisading of the peripheral nuclei; confirming nodular basal cell carcinoma (Figure 1D).
PMC9838765_02
Clinical, dermoscopic, reflectance confocal microscopy (RCM), and histologic characteristics of a 2 mm pigmented basal cell carcinoma. Panel A shows the location on the left upper forehead (black arrow). Panel B indicates dermoscopic features of the same lesion, with the presence of spoke wheel structures and blue-grey dots. Panel C demonstrates a tumor island (red star) with palisading nuclei (yellow arrow) and clefting (red arrow), visualized with RCM. Panel D is the lesion's dermatopathology slide (8x), containing basaloid nests of hyperchromatic nuclei (red star) with peripheral palisading nuclei (yellow arrow) and visible clefting
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On physical examination, a 2 mm pigmented lesion on the left upper forehead was identified (Figure 2A). Spoke-wheel structures and blue-grey dots were present; features that are suggestive of BCC (Figure 2B). Tumor islands, palisading of nuclei, and clefting were present (Figure 2C). Therefore, a biopsy by shave technique was performed, with histologic findings of basaloid epithelial cell aggregates, hyperchromatic nuclei, scant cytoplasm, and palisading of the peripheral nuclei (Figure 2D).
PMC9838765_03
Clinical, dermoscopic, reflectance confocal microscopy (RCM), and histologic characteristics of a 1.5 mm pigmented basal cell carcinoma. Panel A shows the location on the left upper lip (black arrow). Panel B reveals dermoscopic visualization of the lesion, with brown pigment distribution suggestive of maple leaf-like structures, or possible consideration of perifollicular hyperpigmentation. Panel C illustrates the presence of a tumor island (red star) with palisading of nuclei (yellow arrow) and clefting (red arrow) on RCM, confirming the diagnosis of basal cell carcinoma (BCC). Panel D shows a dermatopathology slide of the lesion (8x), with a large basaloid nest containing hyperchromatic nuclei (red star), the presence of melanocytic pigment, and peripheral palisading nuclei (yellow arrow)
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A 44-year-old Fitzpatrick skin type I female with a history of melanoma in-situ presented for a spot check of a 1.5 mm pigmented macule on the left upper lip (Figure 3A). The first dermoscopic interpretation of the small lesion was lentigo maligna due to pigment distribution suggestive of perifollicular hyperpigmentation, whereas the secondary diagnostic consideration was pigmented BCC with consideration of possible maple leaf-like structures (Figure 3B). RCM imaging revealed an irregular epidermal architecture with enlarged keratinocytes, predominantly in a honeycombed pattern, with melanophages, tumor islands, and palisading of nuclei; confirming the diagnosis of BCC and ruling out lentigo maligna (Figure 3C). Histology showed irregular aggregates of basaloid epithelial cells, hyperchromatic nuclei, scant cytoplasm, peripheral nuclear palisading and areas of pigment (Figure 3D).