Dermatoscopy and management of patients with basal cell carcinoma. Review of clinical cases
Summary. The theoretical bases and practical aspects of the dermatoscopy application in clinical practice as a method of basal cell skin carcinoma diagnosis are considered in the article. Dermatoscopic criteria for this type of skin tumor are described in detail. The information about the basic anatomic-histological subtypes and the most expedient ways of tumors eradication, both by surgical and conservative methods, are given. The possibility of using epiluminescent microscopy as a method before surgical planning of the resection limits or control of the topical therapy effectiveness is considered. As long as the disappearance of dermatoscopic criteria in case of basal cell carcinoma is a recovery criterion that can be obtained faster than a macroscopically visible result, at the same time, the presence of such criteria can serve as a basis for repeated courses of treatment. In difficult cases, the use of algorithmic methods to analyze the dermatoscopic image is suggested. Among these, it is recommended to consider «Prediction without pigment», which is a complement to the «Chaos and Clues» algorithm developed by a team of authors to streamline the differential diagnosis of non-pigmented formations and those with unproven pigmentation by melanin. When analyzing this method, the first question to be resolved is the presence of ulcer or white features (white lines, surface keratin tips, white structureless areas, or white circles). These clues are the basis for excision biopsy performing. In case of their absence, vessel analysis is used. There are four monomorphic vascular structures that correspond to a benign diagnosis: red, purple or blue tubercles, centrally located, serpiginous and reticular vessels. All other monomorphic structures, and especially the polymorphic vascular pattern, should be evaluated as a reason for biopsy. Several clinical cases were analyzed at the end of the publication. Illustrative material was provided and dermatoscopic criteria were found, appeared to be a key in the diagnosis of basal cell carcinoma for the patients under consideration.
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