ORIGINAL ARTICLE Accuracy of dermoscopic criteria for discriminating superficial from other subtypes of basal cell carcinoma Aimilios Lallas, MD, a Thrassivoulos Tzellos, MD, c Athanasios Kyrgidis, MD, d Zoe Apalla, MD, c Iris Zalaudek, MD, a,e Athanasios Karatolias, MD, f Gerardo Ferrara, MD, g Simonetta Piana, MD, b Caterina Longo, MD, a Elvira Moscarella, MD, a Alexander Stratigos, MD, h and Giuseppe Argenziano, MD a Reggio Emilia and Benevento, Italy; Thessaloniki, Volos, and Athens, Greece; and Graz, Austria Background: The management of basal cell carcinoma (BCC) depends, among other factors, on its histopathologic subtype. Although dermoscopic criteria of BCC have been investigated, the possible role of dermoscopy in predicting the tumor subtype remains unclear. Objectives: We sought to assess the diagnostic accuracy of dermoscopic criteria for differentiating superficial BCC (sBCC) from other BCC subtypes. Methods: Dermoscopic images of histopathologically confirmed BCCs were retrospectively evaluated for the presence of predefined criteria. Univariate and adjusted odds ratios were calculated. Discriminant functions were used to plot receiver operating characteristic curves. Results: In all, 77 sBCCs and 258 non-sBCCs were included. Maple leafelike areas, short fine superficial telangiectasia, multiple small erosions, and shiny white-red structureless areas were potent predictors of sBCC, each making its diagnosis over 5-fold more likely. Conversely, the presence of arborizing vessels, blue- gray ovoid nests, and ulceration gave 11-fold, 15-fold, and 3-fold increased possibility for the diagnosis of non-sBCCs, respectively. Based on the results of the multivariate analysis, we propose a diagnostic algorithm that can predict the diagnosis of sBCC with a sensitivity of 81.9% and a specificity of 81.8%. Limitations: The retrospective design and the inclusion of only Caucasian patients are limitations. Conclusion: Dermoscopy is reliable in differentiating sBCC from other BCC subtypes. ( J Am Acad Dermatol 10.1016/j.jaad.2013.10.003.) Key words: basal cell carcinoma; dermoscopy; diagnosis; nodular basal cell carcinoma; superficial basal cell carcinoma. T he introduction of nonsurgical treatments, such as imiquimod and photodynamic therapy, radically changed the therapeutic approach of basal cell carcinoma (BCC). 1,2 The latter 2 modalities are recommended as first-line options for the management of superficial BCC (sBCC), 3,4 whereas surgical excision remains the treatment of From the Skin Cancer a and Pathology b Units, Arcispedale Santa Maria Nuova (IRCCS), Reggio Emilia; State Clinic of Dermatol- ogy, Hospital of Skin and Venereal Diseases, Thessaloniki c ; Department of Otolaryngology Head and Neck Surgery, Med- ical School, Aristotle University, Thessaloniki d ; Department of Dermatology, Medical University of Graz e ; private practice, Volos, Greece f ; Anatomic Pathology Unit, Department of Oncology, Gaetano Rummo General Hospital, Benevento g ; and Department of Dermatology, Medical School, University of Athens, Andreas Sygros Hospital. h Supported in part by the Italian Ministry of Health (RF-2010-2316524). Conflicts of interest: None declared. Accepted for publication October 1, 2013. Reprint requests: Aimilios Lallas, MD, Skin Cancer Unit, Arcispedale Santa Maria Nuova, Viale Risorgimento 80, 42100, Reggio Emilia, Italy. E-mail: emlallas@gmail.com. Published online November 20, 2013. 0190-9622/$36.00 Ó 2013 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2013.10.003 Abbreviations used: BCC: basal cell carcinoma CI: confidence interval RR: relative risk sBCC: superficial basal cell carcinoma 1