Dermoscopy as a Tool in Differentiating Cutaneous Squamous Cell Carcinoma From Its Variants

Dimitrios Sgouros; Melpomeni Theofili; Vasileia Damaskou; Sofia Theotokoglou; Konstantinos Theodoropoulos; Alexander Stratigos; Panagiotis Theofilis; Ioannis Panayiotides; Dimitrios Rigopoulos; Alexander Katoulis

doi:10.5826/dpc.1102a50

Dermoscopy as a Tool in Differentiating Cutaneous Squamous Cell Carcinoma From Its Variants

Authors

Dimitrios Sgouros First Department of Dermatology & Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
Melpomeni Theofili Second Department of Dermatology & Venereology, Attikon General University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
Vasileia Damaskou Second Department of Pathology, Attikon General University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
Sofia Theotokoglou Second Department of Dermatology & Venereology, Attikon General University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
Konstantinos Theodoropoulos Second Department of Dermatology & Venereology, Attikon General University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
Alexander Stratigos First Department of Dermatology & Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
Panagiotis Theofilis Department of Internal Medicine, General Hospital of Nikaia Agios Panteleimon, Piraeus, Greece
Ioannis Panayiotides Second Department of Pathology, Attikon General University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
Dimitrios Rigopoulos First Department of Dermatology & Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
Alexander Katoulis Second Department of Dermatology & Venereology, Attikon General University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece

Keywords:

skin tumors, Bowen disease, keratoacanthoma, invasive cutaneous squamous cell carcinoma, dermoscopy

Abstract

Background: Dermoscopic features of cutaneous squamous cell carcinoma (cSCC) have been widely studied, but their accuracy should be further investigated.

Objectives: This study assessed the diagnostic accuracy of a set of predetermined dermoscopic structures for 3 variants of cSCC, namely Bowen disease, keratoacanthoma and invasive cSCC.

Methods: Dermoscopic images of 56 histopathologically confirmed cSCC lesions (9 Bowen disease lesions, 7 keratoacanthomas, and 40 invasive cSCCs) were examined, and the diagnostic accuracy of dermoscopic structures was assessed. Discriminative ability of statistically significant positive predictors was determined using receiver operating characteristic (ROC) curves, and defined as an area under the ROC curve >0.700.

Results: Dermoscopic structures with statistical significance and discriminative ability were: for Bowen disease, clustered glomerular vessels and erosions; for keratoacanthoma, a central keratin plug; and for invasive cSCC, a mixed color of the background. Clustered and glomerular vessels had, for Bowen disease, perfect diagnostic accuracy, with: sensitivity of 88.9% for both features; specificity of 97.9% and 93.6%, respectively; positive predictive value (PPV) of 88.9% and 72.7%, respectively; and negative predictive value (NPV) of 97.8% for both. Erosions had, for BD, high specificity (87.2%) and NPV (91.1%), but low sensitivity (55.6%) and PPV (45.5%). A central keratin plug had, for keratoacanthoma, high specificity (87.8%) and NPV (93.5%), but low sensitivity (57.1%) and PPV (40%). A mixed background color had, for invasive cSCC, high specificity (81.3%) and PPV (89.7%), but low sensitivity (65%) and NPV (48.2%).

Conclusion: Dermoscopy accurately differentiates BD, through clustered glomerular vessels, from keratoacanthoma and invasive cSCC. Dermoscopic structures of keratoacanthoma and invasive cSCC overlap, and only histopathologic analysis differentiates them precisely.

References

Burton KA, Ashack KA, Khachemoune A. Cutaneous squamous cell carcinoma: a review of high-risk and metastatic disease. Am J Clin Dermatol. 2016;17(5):491-508. DOI: 10.1007/s40257-016-0207-3. PMID: 27358187.

Alam M, RatnerD. Cutaneous squamous-cell carcinoma. N Engl J Med. 2001;344(13):975-983. DOI: 10.1056/NEJM200103293441306. PMID: 11274625.

Russo T Piccolo V, Lallas A, Argenziano G. Recent advances in dermoscopy. F1000Res. 2016;5:184. DOI: 10.12688/f1000research.7597.1. PMID: 26949523.

Lallas A, Argenziano G, Zendri E, et al. Update on non-melanoma skin cancer and the value of dermoscopy in its diagnosis and treatment monitoring. Expert Rev Anticancer Ther. 2013;13(5):541-558. DOI: 10.1586/era.13.38. PMID: 23617346.

Zalaudek I, Argenziano G, Leinweber B, et al. Dermoscopy of Bowen's disease. Br J Dermatol. 2004;150(6):1112-1116. DOI: 10.1111/j.1365-2133.2004.05924.x. PMID: 15214896.

Zalaudek I, Argenziano G. Dermoscopy of actinic keratosis, intraepidermal carcinoma and squamous cell carcinoma. Curr Probl Dermatol. 2015;46:70-76. DOI: 10.1159/000366539. PMID: 25561209.

Zalaudek I, Di Stefani A, Argenziano G. The specific dermoscopic criteria of Bowen's disease. J Eur Acad Dermatol Venereol. 2006;20(3):361-362. DOI: 10.1111/j.1468-3083.2006.01445.x. PMID: 16503917.

Papageorgiou C, Apalla Z, Variaah G, et al. Accuracy of dermoscopic criteria for the differentiation between superficial basal cell carcinoma and Bowen's disease. J Eur Acad Dermatol Venereol 2018;32(11):1914-1919. DOI: 10.1111/jdv.14995. PMID: 29633377.

Wozniak-RitoAM, Rudnicka L. Bowen's disease in dermoscopy. Acta Dermatovenerol Croat 2018;26(2):157-161.

Kwiek B, Schwartz RA. Keratoacanthoma (KA): An update and review. J Am Acad Dermatol. 2016;74(6):1220-1233. DOI: 10.1016/j.jaad.2015.11.033. PMID: 26853179.

Lallas A, Pyne J, Kyrgidis A, et al. The clinical and dermoscopic features of invasive cutaneous squamous cell carcinoma depend on the histopathological grade of differentiation. Br J Dermatol. 2015;172(5):1308-1315. DOI: 10.1111/bjd.13510. PMID: 25363081.

Rosendahl C, Cameron A, Argenziano G, et al. Dermoscopy of squamous cell carcinoma and keratoacanthoma. Arch Dermatol. 2012;148(12):1386-1392. DOI: 10.1001/archdermatol.2012.2974. PMID: 22986634.

Zalaudek I, Lallas A, Longo C, et al. Problematic lesions in the elderly. Dermatol Clin. 2013;31(4):549-564, vii-viii. DOI: 10.1016/j.det.2013.06.011. PMID: 24075544.

Gardner IA, Greiner M.. Receiver-operating characteristic curves and likelihood ratios: improvements over traditional methods for the evaluation and application of veterinary clinical pathology tests. Vet Clin Pathol. 2006;35(1): 8-17. DOI: 10.1111/j.1939-165X.2006.tb00082.x. PMID: 16511785.

Argenziano G, Zalaudek I, Corona R, et al. Vascular structures in skin tumors: a dermoscopy study. Arch Dermatol. 2004;140(12):1485-1489. DOI: 10.1001/archderm.140.12.1485. PMID: 15611426.

Sakakibara A, Kamijima M, Shibata S, Yasue S, Kono M, Tomita Y. Dermoscopic evaluation of vascular structures of various skin tumors in Japanese patients. J Dermatol 2010;37(4):316-322. DOI: 10.1111/j.1346-8138.2010.00828.x. PMID: 20507400.

Pan Y, Chamberlain AJ, Bailey M, Chong AH, Haskett M, Kelly JW. Dermatoscopy aids in the diagnosis of the solitary red scaly patch or plaque-features distinguishing superficial basal cell carcinoma, intraepidermal carcinoma, and psoriasis. J Am Acad Dermatol. 2008;59(2):268-274. DOI: 10.1016/j.jaad.2008.05.013. PMID: 18550207.

Mun J-H, kim S-H, Jung D-S, Ko H-C, Kwon K-S, Kim M-B. Dermoscopic features of Bowen's disease in Asians. J Eur Acad Dermatol Venereol. 2010;24(7): 805-810. DOI: 10.1111/j.1468-3083.2009.03529.x. PMID: 20015173.

Payapvipapong K, Tanaka M. Dermoscopic classification of Bowen's disease. Australas J Dermatol. 2015;56(1): 32-35. DOI: 10.1111/ajd.12200. PMID: 25330999.

Russo T, Piccolo V, Lallas A, et al. Dermoscopy of malignant skin tumours: what's new? Dermatology. 2017;233(1):64-73. DOI: 10.1159/000472253. PMID: 28486238.

Adya KA, Inamadar AC, Palit A. Dermoscopy of keratoacanthoma centrifugum marginatum. Indian Dermatol Online J. 2019;10(3):360-362. DOI: 10.4103/idoj.IDOJ_134_18. PMID: 31149601.

Peralta R, Salerni G, Cohen Sabban E, Marin MB, Cabo H. Dermoscopy of a squamous cell carcinoma of the lower lip showing multiple rosettes. Dermatol Pract Concept. 2020;10(1):e2020022. DOI: 10.5826/dpc.1001a22. PMID: 31921509.

Weedon D, malo J, Brooks D, Williamson R. Keratoacanthoma: is it really a variant of squamous cell carcinoma? ANZ J Surg. 2010;80(3):129-130. DOI: 10.1111/j.1445-2197.2010.05219.x. PMID: 20575911.