Dermoscopic characteristics of nodular squamous cell carcinoma and keratoacanthoma
Citation: Lin MJ, Pan Y, Jalilian C, Kelly JW. Dermoscopic characteristics of nodular squamous cell carcinoma and keratoacanthoma. Dermatol Pract Concept. 2014;4(2):2. https://dx.doi.org/10.5826/dpc.0402a02
Received: December 20, 2013; Accepted: January 20, 2014 Published: April 30, 2014
Copyright: ©2014 Lin et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Competing interests: The authors have no conflicts of interest to disclose.
All authors have contributed significantly to this publication.
Corresponding author: Dr. Matthew Lin, Victorian Melanoma Service, Alfred Hospital, Commercial Rd, Prahran, Victoria, 3181, Australia. Tel. +61 (03) 9276 2000; Fax. +61 (03) 9530 5940. Email: email@example.com
Background: Nodular squamous cell carcinoma (SCC) and keratoacanthoma (KA) may mimic a variety of other benign and malignant non-pigmented nodules.
Objectives: To analyze the dermoscopic characteristics of nodular SCC and KA.
Patients/Methods: Retrospective analysis of 50 nodular SCCs and 8 KAs collected from a tertiary dermatology referral center and a private dermatology practice in Melbourne, Australia, between 1 September 2009 and 1 October 2012. All lesions were nodules; defined as firm, elevated, round, palpable tumors with a diameter of 5 mm or more. Clinical and dermoscopic images were evaluated by two examiners in consensus.
Results: Signs of keratinization were frequently observed and included keratin crust/scale (90% of SCCs, 100% of KAs), central keratin mass (32% of SCCs, 88% of KAs), white structureless areas (66% of SCCs, 50% of KAs), white circles (32% of SCCs, 38% of KAs) and white keratin pearls (14% of SCCs, 12% of KAs). Hemorrhage was present in 72% of SCCs and 88% of KAs and preferentially occurred centrally and in areas of keratinization. For nodular SCCs and KAs, we observed glomerular vessels (42% and 25% respectively), linear irregular vessels (36% and 25% respectively), atypical vessels (30% and 38% respectively) and hairpin vessels (30% and 25% respectively).
Conclusions: Hemorrhage, keratinization and vascular features (glomerular, hairpin and linear irregular morphologies) are useful in diagnosing both nodular SCC and KA. Further research on the comparative dermoscopic characteristics of a range of amelanotic nodules is important in order to improve diagnosis of these clinically challenging tumors.