Optional medical device diagnostics – depending on the results of history, physical examination, laboratory diagnostics, and obligatory medical device diagnostics – for differential diagnostic workup
- Dermoscopy (reflected-light microscopy; increases diagnostic certainty; differential diagnostic differentiation from amelanotic melanoma, Bowen’s disease, and squamous cell carcinoma)
- [Basal cell carcinoma:
- Presence of multiple vascular patterns (tree-like vessels).
- Shiny white stripes
- White spots and strands (“Shiny White Structures”).
- Large blue-gray ovoid nests
- Multiple blue-gray globules (pl., lat. for “little balls”)
- Multiple aggregated yellow-white (MAY[Multiple Aggregated Yellow-white]) globules [diagnosis: “non-pigmented basal cell carcinoma” highly probable; association exists mainly with high-risk histological subtypes; sensitivity of MAY globules for basal cell carcinoma: 20, 9%; specificity 99.2%].
- Radicular structures
- Arborizing telangiectasias (tree-like branched visible dilations of superficially located tiny blood vessels).
- Erosions (superficial substance defects confined to the epidermis, without scarring).
- Ulceration (ulceration)
- Aggressive variants: multiple blue-gray clods, tree vessels, and concentric structures]
- Optical coherence tomography (OCT): the method is based on is based on coherent light interferometry; the skin is irradiated with broadband light; the light reflected from the tissue allows the calculation and display of two-dimensional depth section images on a monitor; penetration depth is greater than confocal laser scanning microscopy (KLSM), but at the expense of lower resolution (penetration depth: into subcutaneous tissue (1-2 mm), but with lower resolution: 10-20 μm). Indications: non-melanocytic skin tumors, especially basal cell carcinomas, actinic keratoses, Bowen’s carcinomas, and spinocellular carcinomas (squamous cell carcinomas of the skin).
- Confocal laser scanning microscopy (LSM; confocal laser scanning microscopy) – 3D confocal laser microscopy suitable for measurements at the nanometer scale[sensitivity (percentage of diseased patients in whom the disease is detected by the use of the test, ie. a positive test result occurs) in detecting basal cell carcinoma by confocal laser scanning microscopy was similar to that using a punch biopsy (100% versus 93.94%); as expected, specificity (likelihood that actually healthy individuals who do not have the disease in question are also detected as healthy in the test) was significantly higher by punch biopsy (79% versus 38%)]
- Fluorescence diagnostics (FD; synonym: photodynamic diagnostics, PDD); for in vivo diagnosis of non-melanocytic tumors such as basal cell carcinomas or squamous cell carcinomas of the skin, as well as precancerous lesions (precancerous lesions) such as actinic keratosis
- Abdominal sonography (ultrasound examination of the abdominal organs) – depending on the localization to determine the depth/spread.
- Computed tomography (CT; sectional imaging method (X-ray images from different directions with computer-based evaluation)) – depending on the localization to determine the depth/spread.
- Magnetic resonance imaging (MRI; computer-assisted cross-sectional imaging method (using magnetic fields, that is, without X-rays)) – depending on the localization to determine the depth/spread.
