When the pattern breaks: squamous cell carcinoma

Squamous cell carcinoma (SCC) has less specific dermoscopic features than BCC, but certain patterns should raise suspicion — particularly on sun-damaged skin.

Keratin and scale

Yellow-white structureless areas, often with a central keratin mass. Surface scale or crust is common. This reflects the disorganised keratin production characteristic of SCC.

Vascular patterns

SCC vessels are less distinctive than BCC vessels but still informative:

• Dotted vessels — often clustered
• Hairpin vessels — looped, like a hairpin bend
• Linear irregular vessels — disorganised, without the elegant branching of BCC

Vessels may be distributed throughout the lesion or clustered at the periphery.

White structureless areas

Correspond to keratin or tumour mass. They lack the organisation of normal structures and often appear alongside vascular changes.

Ulceration and red background

Central erosion or ulcer with an irregular base, often crusted. A generalised red background reflects the inflammation and vascularity typical of SCC.