Basal Cell Carcinoma — SCE Dermatology MCQ

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ModerateSkin CancerBasal Cell CarcinomaSCE Dermatology

A 75-year-old man has a pigmented BCC on his cheek. Dermoscopy shows leaf-like areas, spoke-wheel structures, large blue-grey ovoid nests, and arborising (branching tree-like) vessels. Which of these dermoscopic features is most specific for BCC?

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Correct answer: C — Spoke-wheel structures

Spoke-wheel structures are the most specific dermoscopic clue for BCC among the listed options. They are well-circumscribed brown to grey-blue radial projections arising from a darker central hub, histologically reflecting pigmented basal cell tumour nests connected to the epidermis. Arborising vessels, large blue-grey ovoid nests and leaf-like areas are all important diagnostic features of pigmented BCC, but they are less specific than spoke-wheel structures in SBA-style dermoscopy questions. Therefore, the single best answer is C — spoke-wheel structures.

Reference: Dermoscopedia. Basal cell carcinoma dermoscopy chapter, updated 2019. https://dermoscopedia.org/Basal_cell_carcinoma