Dermatology: Practical and Conceptual


Dermatology Practical & Conceptual

Image Letter  |  Dermatol Pract Concept. 2021;11(3): e 2021052 1

An Unexpected Shade of Yellow
Ângela Roda1, André Oliveira2

1 Department of Dermatology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal

2 Dermatology Center, Hospital CUF Descobertas, Lisboa, Portugal

Key words: basal cell carcinoma, skin cancer, cholesterol, dermoscopy, histopathology

Citation: Roda A, Oliveira A. An unexpected shade of yellow. Dermatol Pract Concept. 2021;11(3): e 2021052. 
DOI: https://doi.org/10.5826/dpc.1103a52

Accepted: December 10, 2020; Published: July 8, 2021

Copyright: ©2021 Roda and Oliveira. This is an open-access article distributed under the terms of the Creative Commons Attribution 
License BY-NC-4.0, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original 
authors and source are credited

Funding: None

Competing interests: None

Authorship: Both authors have contributed significantly to this publication

Corresponding author: Ângela Roda, MD. Hospital de Santa Maria. Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal. Email: angela.neto.
roda@gmail.com

Case Presentation

A 45-year-old woman presented with a history of a slowly 

growing asymptomatic solitary yellowish-red papule on 

the face.

Dermoscopy revealed yellow globules over a yellow struc-

tureless area at the level of the upper portion of the lesion, 

in addition to arborizing vessels (AV). The lower half of the 

lesion presented a large blue ovoid nest and red-purple areas 

suggesting traumatic hemorrhage (Figure 1).

Histopathological examination of the skin lesion revealed 

a basal cell carcinoma (BCC) with cholesterol crystal 

deposition.

Teaching Point

When evaluating skin tumors, color is one of the most import-

ant clues for diagnosis. In dermoscopy, the yellow color 

has been associated with the content of keratin, calcium, 

and lipids.

Yellowish structures, including milia-like cysts and yellow 

lobular-like structures, have already been described in BCCs

Figure 1. Basal cell carcinoma with cholesterol crystal deposition, 

dermoscopy. Yellow globules over a yellow structureless area and 

thin arborizing vessels are observed mainly in the upper half of the 

lesion. The lower portion of the lesion presents a large blue ovoid 

nest on the left side and a red-purple background, suggesting trau-

matic hemorrhage.



2 Image Letter  |  Dermatol Pract Concept. 2021;11(3): e 2021052

[1]. Of particular interest, in our case, dermoscopic yellow 

structures corresponded histologically to cholesterol clefts. 

Cholesterol clefts have rarely been reported in cutaneous 

tumors other than lipid-rich tumors. However, cholesterol 

clefts may occur in BCC and have been associated with 

long-lasting disease or microtrauma [2].

References 

1. 1. Bellucci C, Arginelli F, Bassoli S, et al. Dermoscopic yellow 

structures in basal cell carcinoma. J Eur Acad Dermatol Venereol. 

2014;28(5):651-4. DOI: 10.1111/jdv.12092. PMID: 23332004

2. 2. Kim HJ, Park SH, Lee SK, et al.  Cholesterol Clefts in 

Basal Cell Carcinoma: An Under-Recognized Association. 

Am J Dermatopathol. 2018;40(8):594-596. DOI: 10.1097/

DAD.0000000000001147. PMID: 29570130