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Journal of the American Academy of Dermatology
Volume 66, n° 4
pages 589-597 (avril 2012)
Doi : 10.1016/j.jaad.2011.02.011
accepted : 19 February 2011
Original Articles

Dermatoscopy of facial actinic keratosis, intraepidermal carcinoma, and invasive squamous cell carcinoma: A progression model

Iris Zalaudek, MD a, , Jason Giacomel, MBBS b, Karin Schmid, DSc c, Silvia Bondino, MD d, Cliff Rosendahl, MBBS e, Stefano Cavicchini, MD f, Athanasia Tourlaki, MD f, Saturnino Gasparini, MD g, Peter Bourne, MBBS h, Jeff Keir, MBBS i, Harald Kittler, MD j, Laura Eibenschutz, MD k, Caterina Catricalà, MD k, Giuseppe Argenziano, MD l
a Department of Dermatology, Medical University of Graz, Graz, Austria 
b Mends St Medical Centre, South Perth, Australia 
c Department of Psychology, Karl-Franzens-University Graz, Graz, Austria 
d Department of Dermatology, Medical University of Udine, Udine, Italy 
e School of Medicine, University of Queensland, Brisbane, Australia 
f Dermatology Unit, Fondazione Istituto di ricerca e cura a carattere scientifico (IRCCS) Ca’ Granda–Ospedale Maggiore Policlinico, Milan, Italy 
g Dermatology Private Practice, Terni, Italy 
h Skin Cancer Clinic of Toowoomba, Toowoomba Specialist Centre, Toowoomba, Australia 
i Northern Rivers Skin Cancer Clinic, Ballina, Australia 
j Department of Dermatology, Medical University of Vienna, Vienna, Austria 
k Department of Dermatologic Oncology, Santa Maria and San Gallicano Dermatologic Institute– Istituto Fisioterapici Ospidalieri (IFO) of Rome, Rome, Italy 
l Dermatology Unit, First Medical Department, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy 

Reprint requests: Iris Zalaudek, MD, Department of Dermatology, Medical University of Graz, Auenbruggerplatz 8, 8036 Graz, Austria.

Little is known about the dermoscopic features of keratinocyte skin cancer.


We sought to determine the dermoscopic features of facial actinic keratosis (AK), intraepidermal carcinoma (IEC), moderately to poorly differentiated invasive squamous cell carcinoma (SCC), and well-differentiated SCC of the keratoacanthoma type.


This was a retrospective analysis of dermoscopic images of histopathologically diagnosed keratinocyte skin cancer.


A total of 243 (70 AK, 71 IEC, 78 SCC, and 24 keratoacanthomas) tumors of the face from 243 patients (mean age: 71.1 years; range: 44-94 years) were analyzed. The majority of patients had a fair skin type, history of melanoma or nonmelanoma skin cancer, and multiple AK. A red pseudonetwork was significantly associated with AK (P < .001), whereas dotted/glomerular vessels, diffuse yellow opaque scales, and microerosions were significantly more prevalent among IEC (P < .001). Hairpin vessels, linear-irregular vessels, targetoid hair follicles, white structureless areas, a central mass of keratin, and ulceration were significantly associated with invasive SCC (P < .001 for all criteria). Similar patterns as in SCC were observed among keratoacanthomas.


The retrospective design of our study and the lack of assessment of sensitivity and specificity of the dermoscopic criteria are limitations.


Based on our findings we propose a progression model of facial AK developing into IEC and invasive SCC.

The full text of this article is available in PDF format.

Key words : actinic keratosis, dermatoscopy, nonmelanoma skin cancer, squamous cell carcinoma

Abbreviations used : AK, IEC, KA, MM, NMSC, SCC

 Dr Zalaudek is currently a consultant at the Dermatology Unit, First Medical Department, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
 Funding sources: None.
 Conflicts of interest: None declared.

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