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. 2024 Jan 22;14(2):230.
doi: 10.3390/diagnostics14020230.

Color Analysis of Merkel Cell Carcinoma: A Comparative Study with Cherry Angiomas, Hemangiomas, Basal Cell Carcinomas, and Squamous Cell Carcinomas

Dimitra Koumaki  1 , Georgios Manios  2 , Marios Papadakis  3 , Aikaterini Doxastaki  1 , Georgios Vasileiou Zacharopoulos  4 , Alexander Katoulis  5 , Andreas Manios  4
Affiliations

Color Analysis of Merkel Cell Carcinoma: A Comparative Study with Cherry Angiomas, Hemangiomas, Basal Cell Carcinomas, and Squamous Cell Carcinomas

Dimitra Koumaki et al. Diagnostics (Basel). .

Abstract

Merkel cell carcinoma (MCC) is recognized as one of the most malignant skin tumors. Its rarity might explain the limited exploration of digital color studies in this area. The objective of this study was to delineate color alterations in MCCs compared to benign lesions resembling MCC, such as cherry angiomas and hemangiomas, along with other non-melanoma skin cancer lesions like basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), utilizing computer-aided digital color analysis. This was a retrospective study where clinical images of the color of the lesion and adjacent normal skin from 11 patients with primary MCC, 11 patients with cherry angiomas, 12 patients with hemangiomas, and 12 patients with BCC/SCC (totaling 46 patients) were analyzed using the RGB (red, green, and blue) and the CIE Lab color system. The Lab color system aided in estimating the Individual Typology Angle (ITA) change in the skin, and these results are documented in this study. It was demonstrated that the estimation of color components can assist in the differential diagnosis of these types of lesions because there were significant differences in color parameters between MCC and other categories of skin lesions such as hemangiomas, common skin carcinomas, and cherry hemangiomas. Significant differences in values were observed in the blue color of RGB (p = 0.003) and the b* parameter of Lab color (p < 0.0001) of MCC versus cherry angiomas. Similarly, the mean a* value of Merkel cell carcinoma (MCC) compared to basal cell carcinoma and squamous cell carcinoma showed a statistically significant difference (p < 0.0001). Larger prospective studies are warranted to further validate the clinical application of these findings.

Keywords: Merkel cell carcinoma (MCC); basal cell carcinoma; cherry angiomas; color analysis; computer-aided diagnostics; digital dermatology; image processing; neuroendocrine carcinoma; skin cancer; squamous cell carcinoma.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
The left part of this figure is the photograph of the lesion, and the right part is the same photograph showing the boundary that was identified. In the small window in the center, there is the area of surrounding normal skin, which is obtained by incrementing the border of the lesion by 25% and taking a pixel band to estimate the parameters of normal skin depicted in the table along with the geometric characteristics. This zone in this patient corresponds to the area with the light green color.
Figure 2
Figure 2
Histograms representing the color components of both healthy (left) and affected tissue (right), revealing a significant decrease in green within the lesion.
Figure 3
Figure 3
Additionally displayed in this figure are the ITA graphs generated by the software for both healthy and pathological tissues. This figure also includes representations of the average skin color for normal skin and MCC in the small boxes located beneath the ITA graph.
Figure 4
Figure 4
(a) MCC in a patient; (b) cherry angioma; (c) squamous cell carcinoma; and (d) hemangioma.
Figure 5
Figure 5
This figure illustrates the mean color values of red, green, and blue (RGB) as well as L*, a*, b*, and ITA for lesions across all four categories: (a) MCC is highlighted in red; (b) cherry angioma is represented in blue; (c) BCC and SCC are denoted in green; and (d) hemangioma is depicted in purple.
Figure 6
Figure 6
This figure displays the box plot comparing the mean blue color values of RGB between MCC and cherry hemangioma, showing a statistically significant difference (p = 0.03).
Figure 7
Figure 7
This figure displays the box plot comparing the mean b* color values between MCC and cherry hemangioma, showing a statistically significant difference (p < 0.0001).
Figure 8
Figure 8
This figure displays the box plot comparing the mean green color value of RGB between MCC, BCC, and SCC, showing a statistically significant difference (p = 0.03).
Figure 9
Figure 9
This figure displays the box plot comparing the mean a* value of MCC, BCC, and SCC, showing a statistically significant difference (p < 0.0001).
Figure 10
Figure 10
This figure displays the box plot comparing the mean red value of MCC and hemangioma, showing a statistically significant difference (p = 0.030).
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