DERMOSCOPY traits of adnexal tumors in patients with darker skin tones may closely mimic features of malignant neoplasms, creating significant diagnostic uncertainty for clinicians. A new case series highlights the overlapping dermoscopic patterns between benign adnexal tumors and basal cell carcinoma (BCC) in individuals with skin of color, underscoring the need for heightened awareness and refined diagnostic approaches among U.S. dermatologists and general practitioners.
The report, which focuses on patients of African and Indian descent, outlines clinical and dermoscopic presentations of adnexal tumors, a diverse group of skin neoplasms that can be either benign or malignant. The authors also compare these findings with 11 published case reports and three prior case series featuring dermoscopy of adnexal tumors in dark-skinned individuals.
One of the most consistent dermoscopic findings across the cases was the presence of brown blotches or brown structureless areas. These pigmentation patterns reflect increased epidermal melanin and can obscure or mimic features typically used to distinguish benign from malignant lesions. Arborizing vessels, which are often associated with BCC, were frequently observed in benign entities such as trichoepitheliomas, cylindromas, and apocrine hydrocystomas. This overlap complicates the differentiation of these tumors from nodular BCC, particularly in skin of color, where conventional dermoscopic clues may be less distinct.
The findings draw attention to a potential diagnostic blind spot in dermatologic practice and reinforce the need for further studies examining adnexal tumors in diverse populations. Accurate differentiation is critical, as management and treatment decisions hinge on distinguishing benign adnexal lesions from skin cancers.
This case series adds to growing evidence that dermoscopic criteria developed primarily in lighter-skinned cohorts may not adequately apply to darker skin tones. The authors emphasize the importance of tailored diagnostic strategies to improve outcomes and avoid misdiagnosis in skin of color populations.
Reference:
Karampinis E et al. Dermoscopy of Adnexal Tumors in Skin of Colour as a Diagnostic Challenge Extended to Dark Skin Tones. Case Reports Cureus. 2025;17(6):e86501.
