Nodular basal cell nests have minimal connection to the epidermis with the main nest mass primarily localised within the papillary dermis or superficial reticular dermis
Nodular basal cell nests typically present as ovoid structures with a granular texture due to cell composition
Hyporeflectivity due to the basal cells possessing less intracellular keratin
All basal nests have a form of darker hyporeflective border, this characteristic is more prominent in nodular subtypes
Dark halo appearance due to a cleft region fully encompassing the nest and the presence of peripheral palisading
Prominence and thickness of cleft can vary between nests
More prone to have directed vasculature connecting with the nest (arborizing blood vessels)
Can occur as an aggregation of multiple nodules arranged horizontally across a region
Peripheral boundary in larger nodules is typically more visible on lower face of the nest as a more hyporeflective region
Larger nodules displace the normal mottled collagen texture of the dermis with a homogenous fine granularity corresponding to the basal cell population
Some nodules may take up the entire scan area but can be identified by the appearance of a gap between the nest and epidermis showing a fine, yet visible, cleft region
Larger nodules are prone to forming necrotic centres
The loss of the nest’s homogenous texture at the centre is due to necrotic cell debris and the presence of tissue fluid
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