# Dermoscopy of Adnexal Tumors in Skin of Colour as a Diagnostic Challenge Extended to Dark Skin Tones

## TL;DR

This paper explores the challenges of diagnosing adnexal tumors in people with skin of color using dermoscopy, highlighting the need for better understanding and early detection.

## Contribution

The study provides a case series and comparison of dermoscopy features of adnexal tumors in dark-skinned individuals, emphasizing diagnostic challenges.

## Key findings

- Brown blotches or structureless areas are common due to increased epidermal pigmentation.
- Arborizing vessels are frequently seen in various adnexal tumors, complicating differentiation from BCC.
- Early detection is crucial for distinguishing benign from malignant tumors in skin of color.

## Abstract

Skin adnexal tumors represent a wide spectrum of benign and malignant neoplasms, presenting morphological differentiation toward various adnexal structures. Skin of color variations in skin architecture and melanin production have been documented, possibly affecting the development and progression of those tumors, as well as their clinical and dermoscopy image. Therefore, we present a case series of clinical and dermoscopy presentations of adnexal neoplasms in skin of color individuals (Africans and Indians). We also compare these findings with 11 case reports and three case series that presented dermoscopy traits in adnexal tumors in dark-skinned patients found in medical literature.

The most common pigmentation trait found was brown blotches or brown structureless areas, corresponding to the increased epidermal pigmentation. Arborizing vessels, a characteristic of basal cell carcinoma (BCC), are frequently seen in trichoepitheliomas, cylindromas, and apocrine hydrocystomas, raising diagnostic challenges. Differentiating adnexal tumors from nodular BCC in skin of color poses a challenge due to overlapping features. Additional studies on the clinical evaluations of adnexal tumors are warranted. Early detection and prompt diagnosis are crucial, especially when differentiating benign adnexal tumors from malignant skin cancers, as this differential diagnosis significantly influences management and treatment outcomes.