|LETTER TO EDITOR
|Year : 2019 | Volume
| Issue : 2 | Page : 107-108
Rainbow sign in dermatoscopy of nodular basal cell carcinoma
Balakrishnan Nirmal1, AS Krishnaram1, Ramamoorthy Sudhagar2
1 Department of Dermatology, Velammal Medical College and Research Institute, Madurai, Tamil Nadu, India
2 Department of Pathology, Velammal Medical College and Research Institute, Madurai, Tamil Nadu, India
|Date of Web Publication||28-Nov-2019|
Department of Dermatology, Velammal Medical College and Research Institute, Madurai, Tamil Nadu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Nirmal B, Krishnaram A S, Sudhagar R. Rainbow sign in dermatoscopy of nodular basal cell carcinoma. Indian J Dermatopathol Diagn Dermatol 2019;6:107-8
|How to cite this URL:|
Nirmal B, Krishnaram A S, Sudhagar R. Rainbow sign in dermatoscopy of nodular basal cell carcinoma. Indian J Dermatopathol Diagn Dermatol [serial online] 2019 [cited 2020 Apr 2];6:107-8. Available from: http://www.ijdpdd.com/text.asp?2019/6/2/107/271939
Dermatoscope is considered a vital tool in the diagnosis of basal cell carcinoma (BCC), helping in the early diagnosis and differentiating from other clinical mimics. Dermatoscopy of nodular BCC shows arborizing vessels, ulceration, large blue-gray ovoid nests, and multiple blue-gray globules, whereas superficial BCC shows brown pigmented structures including concentric structures, leaf-like areas, spoke wheel areas, erosions, and superficial fine telangiectasia.
A 75-year-old male patient presented with complaints of asymptomatic nodule over the face for 2 years. The lesion started as a small papule and enlarged insidiously to attain the present size. There was a history of occasional bleeding from the lesion. On examination, the nodule was firm in consistency and of size 3 cm × 3 cm present just beneath the ala of the nose [Figure 1]. Dermatoscopic examination was performed using a handheld dermatoscope Dermlite DL3 (3Gen Inc., USA) with ultrasound gel as interface fluid, and images were captured using a Sony DSC W-800 20.1 MP digital camera (Sony Corp., Tokyo, Japan). Dermatoscopy under nonpolarized light showed bluish-white structureless areas and ulceration [Figure 2]. Under polarized light, it showed white structureless areas, white crystalline structures, and multicolor structureless areas called “rainbow sign” [Figure 3]. When toggled between nonpolarized and polarized modes, rainbow sign appeared in polarized mode and disappeared in nonpolarized mode [Video 1]. Excision biopsy of the lesion showed basaloid tumor cells infiltrating dermis and subcutaneous tissue in the form of cords and nests, with peripheral palisading and dilated blood vessels in the stroma [Figure 4].
|Figure 2: Nonpolarized dermatoscopy (×10) showing bluish-white structureless areas (blue arrow) and ulceration (white arrow)|
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|Figure 3: Polarized dermatoscopy (×10) showing rainbow sign (black arrow), white structureless areas (yellow star), and crystalline structures (white arrow)|
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|Figure 4: Histopathology showing islands of basaloid tumor cells with peripheral palisading and dilated blood vessels in the stroma (H and E, ×100)|
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The rainbow pattern under dermatoscopy was first described in Kaposi's sarcoma due to diffraction of light passing through slits of blood vessels. Rainbow pattern, however, was also found in lichen planus, stasis dermatitis, melanoma, atypical fibroxanthoma, and BCC. Rainbow pattern is due to luminescence phenomenon of polarized light interacting with vascular structures present within the lesion. Polarized dermatoscopic features of nodular BCC including rainbow pattern and crystalline structures as described in this case report are less reported in literature.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]