The correlation of pigment content between dermoscopy and histopathology in basal cell carcinoma: A retrospective study

Background Pigmentation significantly impacts the diagnosis and management of basal cell carcinomas (BCCs). Although the dermoscopic-histopathologic correlations in BCCs have been studied, the relationship between quantitative pigment content has not been quantitatively assessed. Aim To quantify the correlation of pigment content between dermoscopy and histopathology in BCCs and to explore the relationship between dermoscopic features and clinical characteristics. Methods We retrospectively analysed clinical/dermoscopic/histopathologic images from 90 histopathologically confirmed BCCs. Pigment content was graded as: non-pigmented (0%), light (<30%), moderate (30-70%), and heavy (>70%) by visual assessment of the lesion involvement. Spearman correlation analysis was used to assess pigment content correlation, and Fisher's exact test was used to evaluate associations between dermoscopic and clinical characteristics. Results A moderate correlation (Spearman's r = 0.5028, p < 0.05) was observed between dermoscopic and histopathological pigment content. Dermoscopic features, including leaf-like areas, spoke-wheel-like structures, and ulceration, were associated with tumour location. Large blue-grey ovoid nests and leaf-like areas were associated with sex, while dotted vessels and leaf-like areas were associated with a disease course <24 months. Limitations The study was constrained by a small sample size and geographic homogeneity, primarily including Asian individuals from a high-BCC-prevalence region. Conclusion Quantitative correlation analysis confirms that dermoscopic pigmentation reflects both melanin density and architectural tumour aggregation, enabling non-invasive assessment of BCC biology.