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Basal cell carcinoma-mimicking lesions in korean clinical settings.
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MedLine Citation:
PMID:  25143670     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Basal cell carcinoma (BCC) is the most common form of skin cancer and possesses various clinical features including translucency, ulceration, pigmentation, telangiectasia, and rolled borders. Accordingly, many cutaneous lesions can mimic BCCs and differential diagnosis is difficult.
OBJECTIVE: To clarify the differences in clinical characteristics between BCCs and BCC-mimicking lesions (BMLs), and to determine which clinical characteristics are helpful for an accurate clinical diagnosis of BCC.
METHODS: We performed clinicopathologic analysis of cutaneous lesions that received a clinical diagnosis of BCC. All lesions included in this study showed more than one of the following characteristics of BCCs: translucency, ulceration, flecked pigmentation, black or blue hue, telangiectasia, and rolled borders. We compared six clinical characteristics between the BCC group and the BML group.
RESULTS: Among 48 lesions in the BML group, there were 15 premalignant or malignant lesions and 33 benign lesions. Various dermatoses mimicking BCC that have not been reported in the dermatological literature were identified, including angiosarcoma, vulvar intraepithelial neoplasm, foreign body granuloma, intravascular papillary endothelial hyperplasia, sarcoidosis, and others. Compared to the BML group, the BCC group had a significantly higher frequency of translucency (76.3% vs. 52.1%, p<0.001), ulceration or erosion (44.2% vs. 27.1%, p=0.022), black or blue hue (40.0% vs. 22.9%, p=0.020), and rolled borders (49.5% vs. 14.6%, p<0.001). Cutaneous lesions with two or less clinical features of BCC were significantly more likely to be BMLs.
CONCLUSION: The results of this study could be helpful for the differential diagnosis of BCCs and BCC-mimicking cutaneous lesions.
Authors:
Hoon-Soo Kim; Tae-Wook Kim; Je-Ho Mun; Margaret Song; Hyun-Chang Ko; Byung-Soo Kim; Moon-Bum Kim
Publication Detail:
Type:  Journal Article     Date:  2014-07-31
Journal Detail:
Title:  Annals of dermatology     Volume:  26     ISSN:  1013-9087     ISO Abbreviation:  Ann Dermatol     Publication Date:  2014 Aug 
Date Detail:
Created Date:  2014-08-21     Completed Date:  2014-08-21     Revised Date:  2014-08-25    
Medline Journal Info:
Nlm Unique ID:  8916577     Medline TA:  Ann Dermatol     Country:  Korea (South)    
Other Details:
Languages:  eng     Pagination:  431-6     Citation Subset:  -    
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Journal Information
Journal ID (nlm-ta): Ann Dermatol
Journal ID (iso-abbrev): Ann Dermatol
Journal ID (publisher-id): AD
ISSN: 1013-9087
ISSN: 2005-3894
Publisher: Korean Dermatological Association; The Korean Society for Investigative Dermatology
Article Information
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Copyright © 2014 The Korean Dermatological Association and The Korean Society for Investigative Dermatology
open-access:
Received Day: 15 Month: 5 Year: 2013
Revision Received Day: 10 Month: 6 Year: 2013
Accepted Day: 13 Month: 6 Year: 2013
Print publication date: Month: 8 Year: 2014
Electronic publication date: Day: 31 Month: 7 Year: 2014
Volume: 26 Issue: 4
First Page: 431 Last Page: 436
PubMed Id: 25143670
ID: 4135096
DOI: 10.5021/ad.2014.26.4.431

Basal Cell Carcinoma-Mimicking Lesions in Korean Clinical Settings
Hoon-Soo Kim1
Tae-Wook KimA1
Je-Ho MunA1
Margaret SongA1
Hyun-Chang KoA1
Byung-Soo Kim1
Moon-Bum Kim1
Department of Dermatology, Pusan National University School of Medicine, Yangsan, Korea.
1Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
Correspondence: Corresponding author: Moon-Bum Kim, Department of Dermatology, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 602-739, Korea. Tel: 82-51-240-7338, Fax: 82-51-245-9467, drkmp@hanmail.net

INTRODUCTION

Basal cell carcinoma (BCC) is the most common form of skin cancer, and its prevalence has been consistently increasing. BCCs have several textbook clinical characteristics such as translucency, ulceration, pigmentation, telangiectasia, and rolled borders. These characteristics are shared by many skin diseases and each subtype of BCCs should therefore be differentiated from a variety of other cutaneous disorders (Table 1)1. A variety of cutaneous lesions can mimic the clinical features of BCCs, including adult-onset xanthogranuloma, rhabdomyomatous mesenchymal hamartoma, Darier's disease, epidermal cysts, lymphoma, and several others (Table 2)2,3,4,5,6,7,8,9,10,11,12,13,14,15. Therefore, the differential diagnosis of BCC and BCC-mimicking lesions (BMLs) is complex, yet there have been no studies clarifying the differences in clinical characteristics between BCCs and BMLs, and which clinical characteristics are most helpful for making accurate clinical diagnoses of BCC. Accordingly, we conducted a comparative study between BCCs and BMLs.


MATERIALS AND METHODS
Six clinical characteristics of BCCs

There are six textbook clinical characteristics of BCCs: translucency, ulceration, pigmentation, telangiectasia, and rolled borders1. In this study, "pigmentation" was divided into flecked pigmentation and black or blue hue since pigmented BCCs, which are frequent in Asia, possess various degrees of pigmentation16. We defined "flecked pigmentation" as multiple small spots of pigmentation, and "black or blue hue" as homogenous pigmentation. More than one of these six clinical characteristics of BCCs was present in all cases reported as a BML, or in cases mistakenly reported as BCC, in the dermatological literature (Table 2).

Subjects

We enrolled 656 patients with cutaneous lesions, of which the first clinical diagnosis was BCC at the Skin Cancer Clinic of the Department of Dermatology at Pusan National University Hospital, from August 2002 to July 2011. The study was approved by the ethics committee of PNUH (E-2013023). All lesions showed more than one of the six characteristics listed above. The number of patients in the BCC group was 608, and in the BML group was 48. The demographic data are shown in Table 3.

Assessment
1) Final diagnoses of the BML group

After histopathologic evaluation, we analyzed which cutaneous diseases can mimic BCC.

2) Comparison of the six characteristics between the BCC group and the BML group

On the basis of clinical photographs, we evaluated how often each characteristic (translucency, telangiectasia, flecked pigmentation, ulceration or erosion, black or blue hue, and rolled borders) was found in the BCC group and the BML group. All statistical analyses were performed by means of IBM SPSS Statistics 21.0 (IBM Co., Armonk, NY, USA).

To compare the six characteristics between the BCC group and the BML group, statistical analysis was performed using Fisher's exact test. The level of significance in this study was set at a p-value of below 0.05.


RESULTS
Final diagnoses of the BML group (Table 4)

Among 48 BMLs, there were 15 premalignant or malignant lesions and 33 benign lesions. Cases of precancerous and malignant lesions included six cases of actinic keratosis; four cases of squamous cell carcinoma; two cases of malignant melanoma; and one case each of angiosarcoma, Paget's disease, and vulvar intraepithelial neoplasia. Benign disorders included six cases of seborrheic keratosis; four cases of intradermal nevus; three cases each of keratoacanthomas, trichoblastoma, and scars; two cases each of trichoepithelioma, compound nevus, and apocrine hidrocystoma; and one case each of cutaneous myxoma, dilated pore of Winer, foreign body granuloma, intravascular papillary endothelial hyperplasia, lymphomatoid keratosis, rosacea, sarcoidosis, and sebaceous hyperplasia.

Comparison of the six characteristics between the BCC group and the BML group

Compared to the BML group, the BCC group had a significantly higher frequency of translucency (76.3% vs. 52.1%, p<0.001), ulceration or erosion (44.2% vs. 27.1%, p=0.022), black or blue hue (40.0% vs. 22.9%, p=0.020), and rolled borders (49.5% vs. 14.6%, p<0.001). In the case of telangiectasia (41.6% vs. 52.1%, p=0.158) and flecked pigmentation (37.9% vs. 43.8%, p=0.416), there was no statistically significant difference between the two groups (Table 5).

With respect to the number of clinical characteristics in each case, when the number present was two or less, the relevant lesions were highly likely to belong to the BML group (35.7% vs. 72.9%, p<0.001). When the number was three or more, they were highly likely to belong to the BCC group (64.3% vs. 27.1%, p<0.001; Fig. 1).


DISCUSSION

The clinical characteristics of BCC are commonly known to include translucency, ulceration, pigmentation, telangiectasia, and a rolled border. Of these, ulceration, pigmentation, and telangiectasia are commonly seen in daily dermatological practice. Therefore, various diseases, including infectious skin disorders, can mimic BCC (Table 1, 2), and diagnostic pitfalls might exist between BCC and BMLs. However, there has been no systematic trial to analyze and resolve these issues.

In this study, the BML group included various malignant and benign dermatoses. Among these, there were a variety of additional cutaneous disorders that have not yet been reported: angiosarcoma, vulvar intraepithelial neoplasm, foreign body granuloma, intravascular papillary endothelial hyperplasia, sarcoidosis, and others (Fig. 2, 3).

Among the six main clinical characteristics, translucency, ulceration or erosion, black or blue hue, and rolled borders were found more frequently in the BCC group and this was statistically significant. In the case of telangiectasia and flecked pigmentation, there was no significant difference between the BCC group and the BML group. Telangiectasia and flecked pigmentation could therefore be less reliable clinical characteristics for the diagnosis of BCCs in Korean clinical practice than the other four. Over the past two decades, laser ablation of benign skin lesions such as nevi or seborrheic keratosis on the face has gained wide popularity in Korea. Accordingly, some patients with BCCs are likely to be treated by laser ablation after being diagnosed with these benign skin tumors17. In this respect, the results of this study may be helpful for the early detection of BCCs in Korea.

In addition, when a lesion shows two or fewer of the six textbook characteristics of BCCs, it is highly likely to be a BML. When three or more clinical characteristics are present, it is highly likely to be a BCC. Therefore, when one or two clinical characteristics of BCCs are observed at the time of cutaneous lesion examination, other cutaneous disorders should be considered before BCC.

In conclusion, we identified more cutaneous disorders capable of mimicking BCCs than have been previously reported in the literature. In cases of BCC in Korea, translucency, ulceration or erosion, black or blue hue, and rolled borders could be more reliable as diagnostic clinical characteristics than telangiectasia and flecked pigmentation. If a cutaneous lesion suspected to be a BCC possesses three or more clinical characteristics of BCCs, including translucency, telangiectasias, flecked pigmentation, ulceration or erosion, black or blue hue, and rolled borders, it is significantly more likely to be a BCC. The results of this study are thought to contribute to the accurate clinical diagnosis of BCC and provide more detailed information compared to dermoscopic findings alone.


ACKNOWLEDGMENT

This study was supported by a Medical Research Institute Grant (2011-08), Pusan National University Hospital.


References
1. Carucci JA,Leffel DJ,Pettersen JS. Basal cell carcinomaGoldsmith LA,Katz SI,Gilchrest BA,Paller AS,Leffell DJ,Wolff KFitzpatrick's dermotology in general medicine8th edNew YorkMcGrow-HillYear: 201212941303
2. Bohn OL,Sanchez-Sosa S. Rhabdomyomatous mesenchymal hamartoma mimicking basal cell carcinomaAm J DermatopatholYear: 20093130931019384077
3. Lovato L,Salerni G,Puig S,Carrera C,Palou J,Malvehy J. Adult xanthogranuloma mimicking basal cell carcinoma: dermoscopy, reflectance confocal microscopy and pathological correlationDermatologyYear: 2010220667019996569
4. Russell DJ,Dutton JJ,Fowler AM. Darier disease mimicking Basal cell carcinoma of the eyelidOphthal Plast Reconstr SurgYear: 200925144146
5. Akinyemi E,Mai L,Matin A,Maini A. Diffuse large B-cell lymphoma mimicking advanced basal cell carcinomaJ Natl Med AssocYear: 20079994895017722675
6. Ghaffar SA,Clements SE,Lear JT. Epidermoid cysts mimicking recurrence of superficial basal cell carcinoma following photodynamic therapyClin Exp DermatolYear: 20073222322417137478
7. Hinz T,Wiechert A,Bieber T,Bauer R,Schmid-Wendtner MH. Lymphoepithelioma-like carcinoma of the skin mimicking a basal cell carcinomaEur J DermatolYear: 20091917918019106051
8. Lott DG,Akst LM,Greene D,Roberts JK. T-cell primary cutaneous anaplastic large cell lymphoma mimicking appearance of large basal cell carcinomaOtolaryngol Head Neck SurgYear: 200613517017116815209
9. Hague J,Ilchyshyn A. Nickel allergy mimicking basal cell carcinomaContact DermatitisYear: 20065434434516787457
10. Bechara FG,Rotterdam S,Hoffmann K,Altmeyer P,Stücker M,Jansen T. Pomade crust on the scalp mimicking recurrent basal cell carcinomaDermatol NursYear: 20031542642714619319
11. Askar S,Kilinc N,Aytekin S. Syringocystadenoma papilliferum mimicking basal cell carcinoma on the lower eyelid: a case reportActa Chir PlastYear: 20024411711912661924
12. Goto M,Sonoda T,Shibuya H,Terashi H,Kai Y,Sato T,et al. Digital syringomatous carcinoma mimicking basal cell carcinomaBr J DermatolYear: 200114443843911251603
13. Ingleton R,Koestenblatt E,Don P,Levy H,Szaniawski W,Weinberg JM. Cutaneous cryptococcosis mimicking basal cell carcinoma in a patient with AIDSJ Cutan Med SurgYear: 1998343459677260
14. Tsao H,Tahan SR,Johnson RA. Chronic varicella zoster infection mimicking a basal cell carcinoma in an AIDS patientJ Am Acad DermatolYear: 1997368318339146560
15. Lobur DM,Bailin PL,Taylor JS. Severe irritant dermatitis mimicking a basal cell carcinomaCleve Clin QYear: 1983504654676230178
16. Ono T,Egawa K,Yamamoto S,Arao T. Pigmented basal cell carcinoma developing on the lower extremities--three cases masquerading as malignant melanomaJ DermatolYear: 1989163253292600270
17. Jung DS,Cho HH,Ko HC,Bae YC,Oh CK,Kim MB,et al. Recurrent basal cell carcinoma following ablative laser proceduresJ Am Acad DermatolYear: 20116472372921414496

Article Categories:
  • Original Article

Keywords: Basal cell carcinoma, Differential diagnosis, Mimicking.

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