Basal Cell Carcinoma-Mimicking Lesions in Korean Clinical Settings

Background: Basal cell carcinoma (BCC) is the most common form of skin cancer and possesses various clinical features including translucency, ulceration, pigmentation, telangiectasia, and rolled borders. Accordingly, many cutaneous lesions can mimic BCCs and differential diagnosis is difficult. Objective: To clarify the differences in clinical characteristics between BCCs and BCC-mimicking lesions (BMLs), and to determine which clinical characteristics are helpful for an accurate clinical diagnosis of BCC. Methods: We performed clinicopathologic analysis of cutaneous lesions that received a clinical diagnosis of BCC. All lesions included in this study showed more than one of the following characteristics of BCCs: translucency, ulceration, flecked pigmentation, black or blue hue, telangiectasia, and rolled borders. We compared six clinical characteristics between the BCC group and the BML group. Results: Among 48 lesions in the BML group, there were 15 premalignant or malignant lesions and 33 benign lesions. Various dermatoses mimicking BCC that have not been reported in the dermatological literature were identified, including angiosarcoma, vulvar intraepithelial neoplasm, foreign body granuloma, intravascular papillary endothelial hyperplasia, sarcoidosis, and others. Compared to the BML group, the BCC group had a significantly higher frequency of translucency (76.3% vs. 52.1%, p < 0.001), ulceration or erosion (44.2% vs. 27.1%, p = 0.022), black or blue hue (40.0% vs. 22.9%, p = 0.020), and rolled borders (49.5% vs. 146.6% p < 0.001). Cutaneous lesions with two or less clinical features of BCC were significantly more likely to be BMLs. Conclusion: The results of this study could be helpful for the differential diagnosis of BCCs and BCC-mimicking cutaneous lesions.