Visualising Isotretinoin-induced Regression of Basal Cell Carcinoma: A Dermoscopic Case Series

Basal cell carcinoma (BCC) is the most common skin cancer, usually arising on sun-exposed sites. While surgery is standard, medical alternatives are needed in select patients. Oral isotretinoin, with anti-proliferative effects, may induce lesion regression, and dermoscopy aids in monitoring response. We report a case series of three patients with BCC showing significant dermoscopic regression on isotretinoin therapy.
Fig 1a: single, oval shaped, black-colored plaque with rolled-out irregular borders and few clear pink areas in between, over the left temple of the face.
Fig 1b: Significant regression of lesion with few remaining black round structures.
Fig 1c: multiple blue-black ovoid nests, white structureless areas, few foci of ulceration and scaling, and white shiny streaks. (Dermoscopy, 40x)
Fig 1d: Marked clearance of blue-gray ovoid nests, along with clearance of ulceration and development of milky-pink areas suggestive of healing. (Dermoscopy, 40x)

Fig2a: Single, oval, plaque with crusting and ulceration over the bridge of her nose towards the left side.
Fig 2b: significant flattening and clearing of lesion.
Fig 2c: ulceration, crusting, and black homogenous areas at the periphery (Dermoscopy, 40x)
Fig 2d: marked decrease in crusting and ulceration, fading brown dots, a prominent central white scar-like area, and no underlying vascular structure or erythema. (Dermoscopy, 40x)

Fig 3a: black coloured oval shaped plaque with superficial ulceration and rolled out highly pigmented margins just below the right eye with a medial thin linear streak of extension.
Fig3b: clearing of ulceration, flattening of lesion with no bleeding.
Fig 3c: extensive ulceration, bleeding and black homogenous areas (Dermoscopy, 40x)
Fig 3d: marked decrease in ulceration, clearance of central pigmentation, white shiny streaks, and blackish pigmented margins. (Dermoscopy , 40x)