Dermoscopy of cutaneous squamous cell carcinoma by anatomical location and risk stratification: a retrospective cross-sectional study

In this system, “very-high risk” includes tumours that are large and/or “poorly differentiated” (meaning the cancer cells look more abnormal under the microscope). We reviewed consecutive cases from January 2011 to December 2021 and included 768 invasive cSCCs with clinical photos, dermoscopy images, and a confirmed diagnosis on histology. Two dermatologists assessed the dermoscopy images without knowing the pathology results, and we used statistical models to identify signs linked to very-high risk tumours.

We found that dermoscopy patterns varied by anatomical site, and that higher-risk groups more often showed ulceration and mixed types of blood vessels. In head and neck tumours, very-high risk (poorly differentiated) cancers were more likely when we saw ulceration and yellow crust (often dried fluid/exudate), and in older patients. Some findings, such as dotted-glomerular vessels, white circles, and vessels mainly at the edge of the lesion, were linked with lower risk.

We conclude that dermoscopy may help clinicians prioritise lesions for faster biopsy and treatment, potentially improving early risk assessment before pathology is available. Dermoscopy is intended to complement histopathology, and our results provide a basis for future prospective, multicentre studies to confirm these patterns and refine their clinical use.