Vascular patterns in basal cell carcinoma

Background Dermoscopy has been proved to increase the diagnostic accuracy of basal cell carcinoma (BCC). Objective To characterize the type and frequency of vascular patterns in superficial and nodular BCCs. Methods We retrospectively analysed the dermoscopic images of 504 histopathologically proven BCCs. Results The most common vascular pattern was represented by arborizing vessels (306/504; 60.7%), which were significantly more frequent in nodular BCCs (nBCCs) compared with superficial BCCs (sBCCs), and in pigmented sBCCs vs. non-pigmented sBCCs (P < 0.0001). Short fine telangectasias (SFTs) were found in 33.1% (167/504) of cases and were significantly more frequent in sBCCs compared with nBCCs (P < 0.0001). Hairpin vessels were detected in 52/504 (10.3%) BCCs. Minor vascular patterns included glomerular vessels (41/504; 8.1%), dotted (21/504; 4.2%), comma vessels (5/504; 1.0%) and polymorphous pattern (9/504; 1.8%). Conclusions Arborizing vessels are prototypic of nBCCs, whereas SFTs are characteristics of sBCCs. Differential diagnosis with squamous cell carcinoma or melanoma is mandatory when a polymorphous pattern is detected.