Dermoscopic features of basal cell carcinoma and its subtypes: A systematic review

J Am Acad Dermatol. 2021 Sep;85(3):653-664. doi: 10.1016/j.jaad.2019.11.008. Epub 2019 Nov 7.


Background: Multiple studies have reported on dermoscopic structures in basal cell carcinoma (BCC) and its subtypes, with varying results.

Objective: To systematically review the prevalence of dermoscopic structures in BCC and its subtypes.

Methods: Databases and reference lists were searched for relevant trials according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were assessed for the relative proportion of BCC dermoscopic features. Random-effects models were used to estimate summary effect sizes.

Results: Included were 31 studies consisting of 5950 BCCs. The most common dermoscopic features seen in BCC were arborizing vessels (59%), shiny white structures (49%), and large blue-grey ovoid nests (34%). Arborizing vessels, ulceration, and blue-grey ovoid nests and globules were most common in nodular BCC; short-fine telangiectasia, multiple small erosions, and leaf-like, spoke wheel and concentric structures in superficial BCC; porcelain white areas and arborizing vessels in morpheaform BCC; and arborizing vessels and ulceration in infiltrative BCC.

Limitations: Studies had significant heterogeneity. Studies reporting BCC histopathologic subtypes did not provide clinical data on pigmentation of lesions.

Conclusion: In addition to arborizing vessels, shiny white structures are a common feature of BCC. A constellation of dermoscopic features may aid in differentiating between BCC histopathologic subtypes.

Keywords: BCC; arborizing vessels; basal cell carcinoma; blue-white veil; concentric structures; corkscrew vessels; dermatoscopy; dermoscopy; dotted vessels; glomerular vessels; hairpin vessels; infiltrative basal cell carcinoma; large blue-grey ovoid nests; leaf-like areas; morpheaform basal cell carcinoma; multiple blue-grey dots and globules; multiple in-focus dots; multiple small erosions; nodular basal cell carcinoma; nonpigmented basal cell carcinoma; pigmented basal cell carcinoma; polymorphous vessels; rosettes; shiny white structures; shiny white-red structureless background; short-fine telangiectasia; spoke wheel areas; superficial basal cell carcinoma; ulceration.

Publication types

  • Systematic Review

MeSH terms

  • Carcinoma, Basal Cell* / diagnostic imaging
  • Dermoscopy
  • Humans
  • Pigmentation
  • Pigmentation Disorders*
  • Skin Neoplasms* / diagnostic imaging