Basal Cell Carcinoma: A Cross-Sectional Study of Clinical, Dermoscopic and Histopathological Evaluation

Abstract

Background : Basal cell carcinoma (BCC) is the most common form of skin cancer. WHO classifies BCC into subtypes based on histopathological characteristics. Dermoscopy is a valuable tool for diagnosing and characterizing BCC lesions. To ensure the best treatment and minimize relapse risk, comprehensive evaluation through clinical, dermoscopic, and histopathological assessments is essential. Aim : The study aims to evaluate basal cell carcinoma (BCC) clinically, dermoscopically, and histopathologically to classify them into high-risk and low-risk groups, aiding in treatment selection based on subtype. Patie nts and Method : The study, conducted at Al Sadar Medical City in Al Najaf, Iraq, from October 2022 to October 2023, was a cross-sectional, clinical observational study focusing on patients suspected of having Basal Cell Carcinoma (BCC). It involved assessing demographic information and clinical characteristics of lesions, including size, location, duration, number, ulceration, and pigmentation. Dermoscopic evaluation utilizing the Dermlite DL100 3GEN dermoscope categorized structures into pigmented, vascular, and nonvascular/nonpigmented groups. Additionally, histopathologic evaluation was conducted to determine the histopathologic subtype of BCC in each case. Results : Forty one patients with a total of 51 BCC lesions were included, 63.4% were male and 36.6% were female, with an average age of 66.3 years. The majority of BCC lesions were on the head and neck (90.2%), with the nose being the most common site. Most cases had solitary lesions (90.2%). Blue-grey ovoid nests (66.7%) being the most frequent dermoscopic feature, followed by shiny white-red structureless areas (60.8%), ulceration (56.9%), short fine telangiectasia (51%), and leaf-like areas (51%). Histopathologically, the most common variant was nodular (58.82%), followed by mixed (19.61%) and superficial (13.73%), among others. Conclusion : Basal cell carcinomas can be classified into low-risk and high-risk groups based on clinical, dermoscopic, and histopathological characteristics. BCCs on the face and neck larger than 1 cm or on the trunk larger than 2 cm, displaying dermoscopic features like shine white streaks and keratin masses, and those demonstrating aggressive growth patterns on histopathological examination are classified as high risk.