Dermoscopy of Pigmented Basal Cell Carcinoma in Darker Skin: Is There A Need For A Tailored Criteria? A Prospective Study of Indian Data

Background: Basal cell carcinoma (BCC) is a nonmelanoma skin cancer with a paucity of dermoscopic studies in pigmented skin. Aims: To describe the clinical and dermoscopic features of patients with BCC in Indian skin. Methods: A tertiary hospital-based prospective cross-sectional study was conducted. Clinical evaluation with dermoscopy in suspected BCC cases was recorded. Those confirmed by histopathology were included. Data were assessed using mean, standard deviation, Spearman rank correlation formula, and Chi-square test. Results: We found 44 BCCs in 40 patients with Fitzpatrick IV and V skin type. All were clinically pigmented BCCs with a mixed subtype of superficial in 15, nodular in 28, and one morpheaform. Dermoscopy of superficial BCCs revealed a maple leaf pattern (86.7%, p = 0.00), spoke-wheel areas (26.7%, p = 0.014), and brown dots (60%, p = 0.03%). Nodular BCCs had arborizing vessels (57.1%, p = 0.003), microarborizing vessels (60.7%, p = 0.006), out-of-focus vessels (84.6%), and short fine telangiectasias (38.5%) ( p = 0.009), ulceration (71.4%, p = 0.00), blue-white veil (89.3%, p = 0.043), crust (82.1%, p = 0.001), and hemorrhage (82.1%, p = 0.00). We described two new pigment patterns: ill-defined coalesced globules in 33 (75%) BCCs and peripheral confluent band-like pigmentation in eight (28.6%) nodular BCCs. Menzies’ criteria were fulfilled by 97.7% of pigmented BCCs; only 13.3% of superficial BCCs fulfilled Lallas’ criteria. Conclusions: On dermoscopy, superficial BCCs showed pigmented structures and nodular BCCs revealed vascular findings, ulceration, crust, hemorrhage, and a blue-white veil. Menzies’ criteria can be recommended in our population. The dermoscopic findings, "ill-defined coalesced globules" and "peripheral confluent band-like pigmentation," reflect the unique presentation of BCC in darker skin.