Research Letter

Differentiation of Dermal Nevus and Basal Cell Carcinoma Based on Optical Super-High Magnification Dermoscopy

Author Affiliation(s)


Although dermoscopy usually allows for discriminating between dermal nevi (DN) and basal cell carcinoma (BCC), the dermoscopic features might occasionally be indistinguishable [ 1 ] .

Optical Super-High magnification dermoscopy (OSHMD) with magnification up to 400x may provide new differentiating structures invisible in conventional dermoscopy [ 2 ] .

Case Presentation

We present the dermoscopic features of two DN and two BCC examined with the Medicam 1000 (Fotofinder System, Bad Birnbach, Germany), at standard 20x and at 400x magnification (OSHMD).

The DN were located on the abdomen of a 36-year-old man ( Fig 1A–C ) and the face of a 45-year-old woman ( Fig 1D–F ). The first DN in standard dermoscopy displayed a blue-grey globule with branched linear vessel in the center and short linear vessels at the periphery ( Fig 1A ). These findings could mislead to the diagnosis of BCC. OSHMD revealed prominent stem and looped vessels, but also multiple small pale brown circular structures of the same size ( Fig 1B ), possibly corresponding to melanocytes in the upper part of dermal nests. In the second patient, conventional dermoscopy revealed a central light brown pigmentation and linear curved vessels distributed throughout the whole lesion ( Fig 1D ). OSHMD showed vessels and brown circular structures similar to the previous case ( Fig 1E ). In both patients, histopathology confirmed the diagnosis of DN ( Fig 1C, F ).

The BCCs developed in a 55-year-old woman who presented with a 5 mm firm papule on the upper lip reported to have appeared several years earlier ( Fig 2A–C ), and a 45-year-old woman with a pink flat papule on the lower eyelid ( Fig 2D–F ). In the first patient, standard dermoscopy revealed branched vessels and brown globules located focally at the periphery ( Fig 2A ). OSHMD revealed aggregated fine pigmented structures, and looped vessels ( Fig 2B ). In the standard dermoscopy of the second patient, a grey globule and branched vessels were noticed ( Fig 2D ), while OSHMD revealed distinctive tree-like vessels with branches and variously shaped fine pigmented structures ( Fig 2E ). Histopathology of both lesions confirmed nodular BCC ( Fig 2C, F ).

In both DN, OSHMD revealed invisible in standard dermoscopy circular pigmented structures, uniform in size and color, with a tendency for an annular arrangement. Based on the comparison with histopathology, and according to the available literature those cells possibly correspond to melanocytes [ 3 ] . Moreover, these cells share similarities with melanocytes of dermal nevi seen under reflectance confocal microscopy (RCM), as hyper-reflective circles or roundish cells homogeneous in shape and size [ 4 , 5 ] . In OSHMD of BCCs, the aforementioned circular structures were absent. Fine pigmented structures observed in BCC could correspond to pigmented basaloid cells and dendritic melanocytes inside the basaloid nests visible in RCM [ 6 ] . Such structures were absent in both cases of DN. Our observations are consistent with previous data suggesting that OSHMD can reveal very fine pigmented structures corresponding to dots or globules, suggestive of BCC [ 2 ] . However, as either looped or branched vessels were present in both DN an BCC cases, the vascular pattern does not appear to be a distinctive feature of neither lesion type.


The OSHMD findings described herein indicate that this technique might significantly enhance the discrimination between DN and BCC by revealing circular cells probably corresponding to typical melanocytes in the DN and the fine pigmented structures in BCC. Our findings require conformation by studies with a larger sample.


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