Polarized Dermoscopy and Ultraviolet-Induced Fluorescence Dermoscopy of Basal Cell Carcinomas in the H- and Non-H-Zones of the Head and Neck.

Abstract

Introduction: Basal cell carcinoma (BCC) is the most common skin cancer, primarily affecting the head and neck region. This study aimed to evaluate the characteristics of BCCs in different facial areas using polarized dermoscopy (PD) and ultraviolet-induced fluorescence dermoscopy (UVFD).

Methods: BCCs were examined using a Dermlite DL5 dermatoscope in polarized and UVFD modes. The tumors were categorized based on their location within the high-risk H-zone (ear and periauricular region, temple, eyes and periorbital area, nose and paranasal region, oral region, chin) and non-H-zone (forehead, cheek, rest of the face, scalp, neck). PD features were characterized according to standard dermoscopic criteria for skin cancer assessment. UVFD characteristics included dark silhouettes, interrupted follicle patterns, ulcerations/erosions, white-blue scales, arborizing vessels, absence of pink-orange or blue-green fluorescence, blue-fluorescent fibers, pink-orange fluorescence, black globules, white depigmentation, white clods, and well-defined margins.

Results: A total of 151 BCCs were analyzed, with 61.6% located in the H-zone, where the nose and paranasal region were the most affected area (37.6%). Nodular (65.6%) and nonpigmented (86%) subtypes predominated in the H-zone. PD most commonly revealed arborizing vessels (52.7%), short fine telangiectasias (46.2%), red-white homogeneous areas (40.9%), and ulcerations/micro-ulcerations (40.9%). Under UVFD, BCCs in the H-zone frequently exhibited dark silhouettes (77.4%), interrupted follicle patterns (51.6%), absence of blue-green (51.6%) or pink-orange fluorescence (44%), and well-defined lesion borders (43%). Compared to non-H-zone tumors, BCCs in the H-zone were significantly more likely to display ulcerations/micro-ulcerations under PD (p = 0.021), and erosions/ulcerations (p = 0.019), blue-fluorescent fibers (p = 0.009), and absence of blue-green fluorescence (p = 0.019) under UVFD.

Conclusion: BCCs in the head and neck exhibit distinct characteristics under UVFD, with certain findings more commonly observed in H-zone tumors. The addition of UVFD to PD serves as a valuable, noninvasive diagnostic tool that enhances early detection of BCCs in this anatomically and cosmetically significant region.