These authors contributed equally to the creation of manuscript.
Dermal changes in superficial basal cell carcinoma, melanoma in situ and actinic keratosis and their implications
Article first published online: 3 OCT 2013
© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Journal of Cutaneous Pathology
Volume 40, Issue 12, pages 1014–1020, December 2013
How to Cite
Dermal changes in superficial basal cell carcinoma, melanoma in situ and actinic keratosis and their implications., , , , , , , .
- Issue published online: 26 NOV 2013
- Article first published online: 3 OCT 2013
- Accepted manuscript online: 12 SEP 2013 12:57PM EST
- Manuscript Accepted: 21 APR 2013
- Manuscript Revised: 11 MAR 2013
- Manuscript Received: 27 MAY 2012
- malignant melanoma;
- non-melanoma skin cancer;
- pathology dermatopathology
Basal cell carcinoma (BCC) has a characteristic stroma, but less is known about the dermal characteristics associated with melanoma in situ (MIS) and actinic keratosis (AK).
Materials and methods
Dermal changes were studied in 301 specimens of AK, BCC and MIS. Subsequently, blinded images of dermal changes from 90 randomly selected cases of those entities were used to assess the predictive value of the dermal changes. Agreement with the final diagnosis was calculated using kappa coefficient (κ).
Fibromyxoid stroma was present in 82% of BCC cases; fibrous stroma was seen in 25% of BCC, 58% of MIS and 35.6% of AK specimens (p < 0.05). A lichenoid inflammatory infiltrate was frequently associated with AK and a perifollicular infiltrate with periadnexal fibrosis with MIS. Blinded evaluation of images of the dermal changes associated with the tumors yielded the correct diagnosis in (54.4, 41.1 and 27.8%; average 41.2%) by the three appraisers. Coefficient of agreement in blinded imaged evaluation with the actual diagnosis was higher in the BCC and MIS compared with AK (κ = 0.37, p = 0.0001; κ = 0.2, p = 0.0005 and κ = −0.06, p = 0.84, respectively).
Dermal features may be helpful in predicting the correct diagnosis when tumor is not visible.