Noninvasive imaging to improve diagnostic accuracy: A case r
Journal of the American Academy of Dermatology presents a case of a 69-year-old woman who was evaluated for a nonspecific flesh-colored papule on the right nasal ala that was bleeding intermittently. On dermoscopic examination, there seemed to be potential evidence of BCC, but there were also features of a benign-appearing crust. Because of this diagnostic uncertainty, the lesion was imaged with OCT. The OCT scan found ovoid hypoechogenic islands, a feature consistent with basal cell tumor nests. We also visualized atrophy of the overlying epidermis and hyperechogenic areas within the dermis consistent with dense collagen, surrounding hypoechogenic structures resembling cross-sections of hair follicles suggestive of angiofibroma.

Consequently, a biopsy was performed. The dermatopathologist initially reviewed multiple sections and the report of “parallel lamella of collagen, which surround cells with prominent polygonal nuclei and are adjacent to ectatic dermal capillaries,” was consistent with a diagnosis of an angiofibroma. Because of discordance between the OCT and histopathologic diagnosis, a request was made to further step section the tissue block. Upon further sectioning, a focus of BCC, nodular type, extending to the base of the specimen was confirmed to be present.

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