Dermoscopic Findings In Common Benign And Malignant Tumours Of The Face

Abstract

Facial lesions are a cause of immense cosmetic concern. Dermoscopy is a non invasive, in vivo technique used for examination of skin lesions. Face can be a site of various benign skin tumours like seborrheic keratosis (SK), actinic keratosis (AK), trichoepithelioma (TE) and syringoma (SG). Malignant tumours like basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and keratoacanthoma (KA) are also seen on the face. Though common facial tumors are well characterized clinically and histopathologically, dermoscopic features of these tumors originating in Indian skin are relatively unexplored. Objective To determine the dermoscopic findings in common benign and malignant tumours of the face. Methods It is a hospital-based, cross-sectional, descriptive study. Patients presenting with clinically suspicious skin tumours of the face irrespective of the age and who did not receive any treatment were included in the study. All patients were subjected to detailed history, clinical and dermoscopic evaluation. Clinical and dermoscopic images were recorded for each patient. The skin lesion which was examined with the dermoscope was biopsied and sent for the histopathological examination.The examined variables were vascular pattern & type, background colour and specific dermoscopic features of various skin tumours of the face. Results A total of 60 patients with benign and malignant tumours of the face were examined during the study period. Out of which, five patients had more than one type skin tumours. 36 lesions were of seborrheic keratosis, 13 were BCC and syringoma x each, 2 were AK and 1 each was hidrocystoma and trichoepithelioma.. Seborrheic keratosis was observed in middle to old age, with equal sex distribution. The presence of comedo like-openings, moth eaten border, network like structures, sharp dermarcation and less common findings; fissures and ridges, milia like cysts and fat fingers help to reach the diagnosis of SK. Blue gray background, arborizing vessels, blue grey globules & dots, blue grey ovoid nest, featureless areas, maple leaf like area and shiny red white structureless areas are the predominant findings in BCC. The principal dermoscopic findings in syringoma were dilated pores, homogenous light brown areas, multiple hypopigmentation and light brown network at periphery. In AK, telangiectasia, pink-red pseudonetwork, yellow keratotic plugs, multiple slate grey to dark brown dots and globules and targetoid like appearance help in the diagnosis. Presence of sharp demarcation, white globules and homogenous skin coloured areas were the predominant findings in eccrine hidrocystoma. The dermoscopic findings in pigmented TE are tumour border, milia like cyst and black speckled globules.

Conclusion The gold standard for diagnosis of facial skin tumors is histopathology, which is invasive and time consuming. There are specific dermoscopic pattern for each skin tumours of the face that improves the diagnosis of these disorders. Dermoscopy may obviate the need of skin biopsy in some cases and improves the accuracy of clinical diagnosis.