Características dermatoscópicas e sua relação histopatológica no diagnóstico dos diferentes tipos de carcinoma basocelular

Abstract

INTRODUCTION: Basal cell carcinoma (BCC) is the most frequent cancer in humans, and it has become more frequent in the last years. It can be locally invasive, but it rarely metastasizes. The diagnosis is made clinically, and then verified by biopsy and histopathology. Dermoscopy is an inexpensive, non-invasive, in vivo method which allows the examination of morphologic features that are not visible to the naked eye. The diagnostic accuracy of dermoscopic criteria in differentiating superficial basal cell carcinomas from other histological subtypes still needs further studies to confirm and establish protocols for the use and interpretation of data. OBJECTIVES: The aim of this study is to analyze dermoscopic features in BCC differentiation and their correlation with histopathological subtypes, aiming at increasing diagnosis’ accuracy, providing the best treatment and cure control in an individualized way, providing early diagnosis and the creation of a dermoscopic diagnosis algorithm of these tumors to improve the treatments of health care system (SUS/DF) users. METHODS: Analytical, observational study with longitudinal prospective outline. The study included 104 patients, both genders, with clinically confirmed Basal cell carcinoma, treated at the skin cancer emergency room at Asa Norte’s Regional Hospital (SES/DF). The IBM SPSS 3 (Statistical Package for the Social Sciences) 2015 program was used and the level of significance used during all the study was 5%. Participants who had 164 lesions recorded by digital dermoscopy with polarized and unpolarized light with the Fotofinder™️ device were included in the research. They had a biopsy with compatible anatomopathological, between September 2019 and April 2021. After confirming the clinical hypothesis of BCC, surgical excisions of the lesions were performed with a 3-5 millimeter safety margin and sent for histopathological analysis to confirm the diagnosis. RESULTS: results are divided in descriptive analysis, association and multiple regression of the data of 104 individuals with confirmed lesions from dermoscopic and histopathological diagnosis of Basal cell carcinomas. There was no significant difference between genders, participants mean age was 65 years and most frequent phototypes were II (40.38%) and III (47.12%); the most frequent location of the lesions were the face (47.56%), followed by the trunk (31.10%). Non superficial tumors were more frequently on the head and neck, while superficiais tumors were found more frequently in the trunk. Dermoscopic features analysis showed the prevalence of arborizing telangiectasias (64.63%), followed by milky-pink to red background (50%), pigmented islands and blue-gray globules (42.07%), concentric structures (40.24%), short fine telangiectasias (39.02%), blue-gray ovoid nests (34.15%), spoke wheel-like areas (32.22%), erosion/ulceration (26.83%), maple leaf-like areas (26.83%) and white streaks (19.51%). The most common type of BCC was nodular (51.83%), followed by superficial (21.95%) and others (sclerodermiform, adenoid and cystic - 12.20%). Mixed tumors were divided into nodular/superficial (4,88%) and nodular/others (9.15%). Regarding the depth of the tumors in the histopathological examination, there was a predominance of involvement of the reticular dermis in 89.02%; vascular and/or perineural invasion in only 0.61%, histopathological ulceration in 16.46%, while melanin pigment in 21.95% of the lesions. Free lateral surgical margins (98.17%) and free deep surgical margins (93.90%). Arborizing telangiectasias, blue-gray ovoid nests, dermoscopic ulceration, and blue-gray globules were significantly less present in superficial-type lesions compared to the other histological subtypes. Spoke wheel-like structures were significantly more present in mixed tumors of the histological nodular/superficial type compared to the other subtypes (62.50%). Short fine telangiectasias and multiple small erosions were significantly more present in superficial histological lesions (83.33% and 22.22%). The papillary dermis was more frequently affected in the superficial subtype (33.33%), and the hypodermis level and histopathological ulceration were more frequently found in the other histological subtypes (sclerodermiform, adenoid and cystic – 15% and 35% respectively). Deep surgical margins compromised were more frequently found in lesions of the nodular/other type (sclerodermiform, adenoid and cystic - 26.67%), as well as the finding of arborizing telangiectasias in 90% of these lesions. The superficial subtype had a lower percentage of findings of arborizing telangiectasias (13.89%), blue-gray ovoid nests and dermoscopic ulceration (5.56% in each), and multiple dots and bluegray globules (19.44%) compared to other subtypes. Tumors with arborizing telangiectasias were 23.19 times more likely to be nodular or other non-superficial subtypes, lesions with grayish-blue ovoid nests, dermoscopic ulceration and multiple blue-gray dots and globules were 14.40; 8.30 and 3.89 times more likely, respectively, to be nodular or other non-superficial subtypes.Short fine telangiectasias and erosions were 13.84 and 5.81 times more likely, respectively, to be tumors of the superficial subtype. In the logistic regression for the histological outcome when inserting the dermoscopic variables, predictive power increased from 78% to 92.1%. In the multiple context, the presence of arborizing telangiectasias, dermoscopic ulceration and multiple dots and blue-gray globules increase by 13.47; 20.74 and 3.38 times, respectively, the chance of tumors being other histological (non-superficial) subtypes. In an opposite way, the presence of short fine telangiectasias increases the chance of the tumors being of the superficial type by 4.90 times. CONCLUSIONS: Based on the results presented, the dermoscopic characteristics of basal cell carcinomas were correlated with the histological subtypes and helped in the diagnostic and appropriate therapeutic decision in the management of these tumors; dermoscopy of arborizing telangiectasias, ovoid nests and blue-gray dots and globules and dermoscopic ulceration increased the chance of diagnosing non-superficial basal cell carcinomas in 23,14, 8 and 3.8 times; while the finding of short fine telangiectasias and multiple small erosions increased the chance of diagnosing superficial tumors by 13.8 and 5.8 times. The data coincides with the literature and statistically confirmed the first dermoscopic findings. An algorithm was developed with the aim of optimizing the use of the dermatoscope and assisting professionals, especially within the SUS environment, in the diagnosis, treatment choice and monitoring of these tumors.