Multiple aggregated yellow-white globules may aid BCC diagnosis

Multiple aggregated yellow-white globules were observed in more than one-fifth of basal cell carcinoma cases in a case-control study.

“Diagnosis of nonpigmented BCC remains limited to arborizing vessels, ulceration and shiny white structures,” Cristian Navarrete-Dechent, MD, of the dermatology service in the department of medicine at Memorial Sloan Kettering Cancer Center, New York, and colleagues wrote. “The presence of multiple aggregated yellow-white globules may aid the diagnosis of nonpigmented basal cell carcinoma, particularly high-risk subtypes on the head and neck.”

Diagnostic accuracy of multiple aggregated yellow-white globules in identifying basal cell carcinoma (BCC) served as the primary endpoint. The researchers also aimed to determine associations between BCC location and subtype.

The mean age of patients in the cohort was 63.1 years. Men comprised 58.1% of the population.

Results showed that 29.6% of the 656 lesions were located in the head and neck; 44.4% were diagnosed as BCC.

Clinicians observed multiple aggregated yellow-white globules in 21% of BCC cases and in 0.8% of other diagnoses (P < .001). When the globules were present in head and neck lesions, the odds ratio for a diagnosis of BCC was 14.1 (95% CI, 4.2-47.4).

Analysis showed an odds ratio for BCC diagnosis of 32.0 (96% CI, 9.9-103.2). Moreover, a correlation between multiple aggregated yellow-white globules and diagnosis of histologic high-risk BCC was reported (OR = 6.5; 95% CI, 3.1-14.3). The researchers failed to observe these globules in superficial BCC.

Looking closer at the globules as a predictive tool, the researchers reported their presence as having a sensitivity of 20.9% (95% CI, 16.4%-26.1%), a specificity of 99.2% (95% CI, 97.6%-99.8%), a positive predictive value of 95.3% (95% CI, 86.6%-94.5%) and a negative predictive value of 61% (95% CI, 59.6%-62.4%), according to the findings.

“The findings suggest that [multiple aggregated yellow-white] globules may have utility as a new BCC dermoscopic criterion with a high specificity,” Navarrete-Dechent and colleagues wrote. “[Multiple aggregated yellow-white] globules were negatively associated with superficial BCC and positively associated with deeper-seated, histologic, higher-grade tumor subtypes.”