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LOS CABOS, MEXICO — Jet-black dots that resemble marks from a ballpoint pen may be an easily overlooked sign of basal cell carcinoma, Dr. Jennifer L. Vesper said at the annual meeting of the Noah Worcester Dermatological Society.
Dr. Vesper first noticed the tiny black dots on a 51-year-old female patient's forehead in the vicinity of a suspicious lesion that turned out to be basal cell carcinoma (BCC).
Once she was attuned to looking for them, she began to notice the dots on other patients as well.
“I came to realize even a focus of black pigment, often showing up as a very dark black dot, may be the first sign of basal cell carcinoma,” she said.
Since that first patient in 1996, she has documented the dots as a presenting sign of BCC in 14 patients.
“I may or may not see erythema or pearliness upon stretching of the skin,” said Dr. Vesper, a dermatologist in private practice in Bradenton, Fla.
In one patient who presented with a typical BCC with focal black dots on the abdomen, Dr. Vesper noticed more small, ink-black, “slightly papular” dots on the patient's chest on otherwise normal-appearing skin. She and the patient agreed that if the abdominal lesion proved to be BCC, another biopsy would be taken of the chest.
The second biopsy confirmed BCC on the chest.
Dr. Vesper examined an 89-year-old patient with a history of three episodes of BCC and found several lesions dotted with pinpoints of black pigment. When she biopsied six of the lesions, two revealed pigmented BCC, and three showed superficial BCC. Three of the lesions had clear margins. The patient had no history of radiation or arsenic exposure. Histology of clinically uniform-appearing lesions may show various patterns, including pigmented keratinous microcysts, one dot of pigment in a central necrotic tumor nest, pigment in melanophages but not in tumor, or pigment within a tumor and melanophages. Differential diagnosis may include melanoma, compound nevi, angiokeratoma, solar elastosis, or even open comedones.
A biopsy is prudent unless a patient has many dotted lesions, of which some have proved to be BCC, in which case the patient may opt to just have them all removed.
In one case, the biopsy of a lesion with jet-black dots initially came back with a diagnosis of solar elastosis, but after a section, the diagnosis was revised to BCC.
Dr. Vesper reviewed a recent publication chronicling “pigmented speckling” as a distinguishing feature of BCC in 17 patients, 15 of whom had tumors on the head and neck (Dermatol. Surg. 2004;30:1553–5). Although these cases were more focused than cases she has seen, she said the report likely reflects her same observations.
LOS CABOS, MEXICO — Jet-black dots that resemble marks from a ballpoint pen may be an easily overlooked sign of basal cell carcinoma, Dr. Jennifer L. Vesper said at the annual meeting of the Noah Worcester Dermatological Society.
Dr. Vesper first noticed the tiny black dots on a 51-year-old female patient's forehead in the vicinity of a suspicious lesion that turned out to be basal cell carcinoma (BCC).
Once she was attuned to looking for them, she began to notice the dots on other patients as well.
“I came to realize even a focus of black pigment, often showing up as a very dark black dot, may be the first sign of basal cell carcinoma,” she said.
Since that first patient in 1996, she has documented the dots as a presenting sign of BCC in 14 patients.
“I may or may not see erythema or pearliness upon stretching of the skin,” said Dr. Vesper, a dermatologist in private practice in Bradenton, Fla.
In one patient who presented with a typical BCC with focal black dots on the abdomen, Dr. Vesper noticed more small, ink-black, “slightly papular” dots on the patient's chest on otherwise normal-appearing skin. She and the patient agreed that if the abdominal lesion proved to be BCC, another biopsy would be taken of the chest.
The second biopsy confirmed BCC on the chest.
Dr. Vesper examined an 89-year-old patient with a history of three episodes of BCC and found several lesions dotted with pinpoints of black pigment. When she biopsied six of the lesions, two revealed pigmented BCC, and three showed superficial BCC. Three of the lesions had clear margins. The patient had no history of radiation or arsenic exposure. Histology of clinically uniform-appearing lesions may show various patterns, including pigmented keratinous microcysts, one dot of pigment in a central necrotic tumor nest, pigment in melanophages but not in tumor, or pigment within a tumor and melanophages. Differential diagnosis may include melanoma, compound nevi, angiokeratoma, solar elastosis, or even open comedones.
A biopsy is prudent unless a patient has many dotted lesions, of which some have proved to be BCC, in which case the patient may opt to just have them all removed.
In one case, the biopsy of a lesion with jet-black dots initially came back with a diagnosis of solar elastosis, but after a section, the diagnosis was revised to BCC.
Dr. Vesper reviewed a recent publication chronicling “pigmented speckling” as a distinguishing feature of BCC in 17 patients, 15 of whom had tumors on the head and neck (Dermatol. Surg. 2004;30:1553–5). Although these cases were more focused than cases she has seen, she said the report likely reflects her same observations.
LOS CABOS, MEXICO — Jet-black dots that resemble marks from a ballpoint pen may be an easily overlooked sign of basal cell carcinoma, Dr. Jennifer L. Vesper said at the annual meeting of the Noah Worcester Dermatological Society.
Dr. Vesper first noticed the tiny black dots on a 51-year-old female patient's forehead in the vicinity of a suspicious lesion that turned out to be basal cell carcinoma (BCC).
Once she was attuned to looking for them, she began to notice the dots on other patients as well.
“I came to realize even a focus of black pigment, often showing up as a very dark black dot, may be the first sign of basal cell carcinoma,” she said.
Since that first patient in 1996, she has documented the dots as a presenting sign of BCC in 14 patients.
“I may or may not see erythema or pearliness upon stretching of the skin,” said Dr. Vesper, a dermatologist in private practice in Bradenton, Fla.
In one patient who presented with a typical BCC with focal black dots on the abdomen, Dr. Vesper noticed more small, ink-black, “slightly papular” dots on the patient's chest on otherwise normal-appearing skin. She and the patient agreed that if the abdominal lesion proved to be BCC, another biopsy would be taken of the chest.
The second biopsy confirmed BCC on the chest.
Dr. Vesper examined an 89-year-old patient with a history of three episodes of BCC and found several lesions dotted with pinpoints of black pigment. When she biopsied six of the lesions, two revealed pigmented BCC, and three showed superficial BCC. Three of the lesions had clear margins. The patient had no history of radiation or arsenic exposure. Histology of clinically uniform-appearing lesions may show various patterns, including pigmented keratinous microcysts, one dot of pigment in a central necrotic tumor nest, pigment in melanophages but not in tumor, or pigment within a tumor and melanophages. Differential diagnosis may include melanoma, compound nevi, angiokeratoma, solar elastosis, or even open comedones.
A biopsy is prudent unless a patient has many dotted lesions, of which some have proved to be BCC, in which case the patient may opt to just have them all removed.
In one case, the biopsy of a lesion with jet-black dots initially came back with a diagnosis of solar elastosis, but after a section, the diagnosis was revised to BCC.
Dr. Vesper reviewed a recent publication chronicling “pigmented speckling” as a distinguishing feature of BCC in 17 patients, 15 of whom had tumors on the head and neck (Dermatol. Surg. 2004;30:1553–5). Although these cases were more focused than cases she has seen, she said the report likely reflects her same observations.