An 83 year old lady presented with an 8 week history of a new skin nodule on her left cheek. What do you see dermoscopically and what is the most likely diagnosis?
Dermoscopy - Introduction, Terminology and Structures
A document to help you understand the dermoscopic descriptions used in this blog.
Dermoscopy Algorithm
To help you work through dermoscopic cases.
There is a central area of keratin with a largely structureless yellow periphery in which there are multiple arborising vessels. So is this a BCC?
This is not a BCC, but rather a keratoacanthoma-like squamous cell carcinoma (SCC).
While we usually associate arborising vessels with BCC, anything that has a stretched shoulder of skin may have arborising vessels within. The reason why this is not a BCC is the combination of:
- the history if far too short, BCC grow at 2-4 mm a year
- the central core of keratin is in keeping with an epidermal lesion, not a BCC
- the arborising vessels are only at the periphery
Most keratoacanthoma (or KA like SCC) are symmetrical and dome-shaped with a skin-coloured shoulder of skin, however, a small subgroup may have a yellow/white periphery. The main clue to the diagnosis is the rate of growth.
Copied with kind permission from South Tees Hospitals NHS Foundation Trust.
