The correct answer is C. Maple leaf structures.

Maple leaf structures on dermoscopy support the diagnosis of basal cell carcinoma.

This question asks the examinee to identify a pigmented BCC and select the most closely associated dermoscopic finding. In the case of this dark blue-black irregular papule at the alar crease, initial concern for melanoma is quite reasonable. However, on close inspection, there is a subtly rolled border, suggesting the correct diagnosis, pigmented BCC. Dermoscopy can assist in distinguishing between pigmented BCCs and other pigmented lesions. Among the answer choices, maple leaf structures (choice 3) are most closely associated with BCC. The starburst pattern (choice 1) is classically seen in pigmented spindle cell nevus of Reed. Blue-whitish veil (choice 2), regression structures (choice 4), and irregular streaks (choice 5) are features of melanoma, not routinely observed in pigmented BCC.

References:

Cameron MC, Lee E, Hibler BP, et al. Basal cell carcinoma: Contemporary approaches to diagnosis, treatment, and prevention. J Am Acad Dermatol. 2019 Feb;80(2):321-339.

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