Dermoscopedia

***div class="mw-parser-output"> ***div style="display: none"> ***p> ***a href= "https://dermoscopedia.org/Glossary:Reed_nevus" title="Glossary:Reed nevus">Reed nevus ***/a>, ***a href= "https://dermoscopedia.org/Glossary:Spitz_nevus" title="Glossary:Spitz nevus">Spitz nevus ***/a>, ***a href= "https://dermoscopedia.org/Glossary:Non-pigmented" title="Glossary:Non-pigmented">Non-pigmented ***/a>, ***a href= "https://dermoscopedia.org/Glossary:Pigmented" title="Glossary:Pigmented">Pigmented ***/a>, ***a href= "https://dermoscopedia.org/Glossary:Evolution" title="Glossary:Evolution">Evolution ***/a>, ***a href= "https://dermoscopedia.org/Glossary:Starbust_pattern" title="Glossary:Starbust pattern">Starbust pattern ***/a>, ***a href= "https://dermoscopedia.org/Glossary:Diagnosis" title="Glossary:Diagnosis">Diagnosis ***/a>, ***a href= "https://dermoscopedia.org/Glossary:Management" title="Glossary:Management">Management ***/a> ***a href= "https://dermoscopedia.org/Cite:Spitz_/_Reed_nevi" title="Cite:Spitz / Reed nevi">Spitz – cite! ***/a> ***a href= "https://dermoscopedia.org/Message:Spitz_/_Reed_nevi" title="Message:Spitz / Reed nevi">Spitz (message) ***/a> ***a href= "https://dermoscopedia.org/Participate:Spitz_/_Reed_nevi" title="Participate:Spitz / Reed nevi">Spitz – participate! ***/a> ***/p> ***div style="display: none"> User= ***/div> ***/div> ***div id="toc" class="toc" role="navigation" aria-labelledby="mw-toc-heading"> ***input type="checkbox" role="button" id="toctogglecheckbox" class="toctogglecheckbox" style="display:none" /> ***div class="toctitle" lang="en" dir="ltr"> ***h2 id="mw-toc-heading">Contents ***/h2> ***span class="toctogglespan"> ***label class="toctogglelabel" for="toctogglecheckbox"> ***/label> ***/span> ***/div> ***ul> ***li class="toclevel-1 tocsection-1"> ***a href="#Introduction"> ***span class="tocnumber">1 ***/span> ***span class="toctext">Introduction ***/span> ***/a> ***/li> ***li class="toclevel-1 tocsection-2"> ***a href="#Dermoscopic_criteria"> ***span class="tocnumber">2 ***/span> ***span class="toctext">Dermoscopic criteria ***/span> ***/a> ***ul> ***li class="toclevel-2 tocsection-3"> ***a href="#Non_pigmented_Spitz_nevus"> ***span class="tocnumber">2.1 ***/span> ***span class="toctext">Non pigmented Spitz nevus ***/span> ***/a> ***/li> ***li class="toclevel-2 tocsection-4"> ***a href="#Pigmented_Spitz_nevus"> ***span class="tocnumber">2.2 ***/span> ***span class="toctext">Pigmented Spitz nevus ***/span> ***/a> ***/li> ***/ul> ***/li> ***li class="toclevel-1 tocsection-5"> ***a href="#Natural_evolution_of_Spitz_nevi"> ***span class="tocnumber">3 ***/span> ***span class="toctext">Natural evolution of Spitz nevi ***/span> ***/a> ***/li> ***li class="toclevel-1 tocsection-6"> ***a href="#Diagnosis_and_Management"> ***span class="tocnumber">4 ***/span> ***span class="toctext">Diagnosis and Management ***/span> ***/a> ***/li> ***/ul> ***/div> ***h2> ***span class="mw-headline" id="Introduction">Introduction ***/span> ***/h2> ***p>In 1948, Sophie Spitz described a group of melanocytic lesions of children, first considered as “melanomas of childhood ***sup id="cite_ref-PM18859360_1-0" class="reference"> ***a href="#cite_note-PM18859360-1">[1] ***/a> ***/sup>, and subsequently histologically categorized as benign melanocytic proliferations, then renamed as “Spitz nevi”. ***/p> ***p>The majority of Spitz nevi occur in patients younger than 20 years and are less common in adulthood and elderly ***sup id="cite_ref-PM16301385_2-0" class="reference"> ***a href="#cite_note-PM16301385-2">[2] ***/a> ***/sup>. Clinically, the Spitz nevus (SN) appears as a solitary, asymptomatic, round to oval, dome-shaped, papule or nodule usually located on the head, neck or extremities of young individuals. In its classic clinical appearance it is pink or red in colour due to a low melanin production and has a rapid growth; however, brown and even black pigmented SN do exist and are especially seen in young adults. In 1975, Reed et al. described a benign pigmented melanocytic lesion commonly founds on the lower extremities of young female, that after was titled as “Reed nevus”. This kind of lesion, histopathologically presents a heavy pigmentation due to oval-spindle melanocytes arranged in nest and fascicles, whereas clinically appears as a solitary, dark brown to black, dome-shape papule or jet-black plaque. ***/p> ***p>Since 1978, the nosological autonomy of Reed nevus from Spitz nevus has been inquired. Some authors include Reed nevus to the morphological spectrum of Sptiz nevus, while other authors still classify Reed nevus as an independent entity differentiated from pigmented Spitz nevus. The histopathologic distinction between Spitz nevus and Reed nevus is often matter of great debate ***sup id="cite_ref-3" class="reference"> ***a href="#cite_note-3">[3] ***/a> ***/sup>. Nowadays, we distinguish two clinical variants of SN, the classical and the pigmented types, the latter include Reed nevus. ***/p> ***p>The most important issue of SN is their propensity to mimic melanoma clinically, dermatoscopically and histopathologicallly. Moreover, some melanomas histopathologically may resemble Spitz nevi for their “Spitzoid” features and for this reason have been called “Spitzoid melanomas.” ***/p> ***p>Spitzoid lesions represent a difficult and controversial group of tumours, in terms of clinical identification, biologic behaviour and management strategies. Spitz and Reed nevi are benign tumours, but on the other side of the spectrum of spitzoid lesions, there are “Spitzoid melanomas” undoubtedly malignant. Between these two extremes, a series of spitzoid lesions, defined as “ atypical Spitz tumors” and “ melanocytic tumors of uncertain malignant potential (MELTUMP) ***sup id="cite_ref-PM24075543_4-0" class="reference"> ***a href="#cite_note-PM24075543-4">[4] ***/a> ***/sup>”, do exist. This is the major reason why evidence-based management guidelines for these kinds of tumours are difficult to define. ***br /> ***/p> ***div style="max-width:400px"> ***p> ***div class="videoWrapper"> ***iframe width="400" height="300" src="https://www.youtube.com/embed/ER-Oh9CShr8" frameborder="0" allowfullscreen> ***/iframe> ***/div> ***br /> ***/p> ***/div> ***h2> ***span class="mw-headline" id="Dermoscopic_criteria">Dermoscopic criteria ***/span> ***/h2> ***p>The use of dermoscopy has increased the accuracy in the diagnosis of SN allowing a better understanding of their evolving behavior. Spitz/Reed nevi can be classified according six different dermoscopic appearances, namely, vascular (pink homogenous), globular, starburst, reticular, atypical and homogenous pattern. In their growing phases, Spitz nevi evolve from globular pattern to a starburst pattern with regular streaks at the periphery (finger like or globule like). After several months, the peripheral projections disappear and the lesion becomes stable with a dermoscopic homogeneous, structureless brown-to-black pigmentation. Finally, in the last phases the lesion involves and loses its pigmentation ***sup id="cite_ref-PM12074862_5-0" class="reference"> ***a href="#cite_note-PM12074862-5">[5] ***/a> ***/sup> ***sup id="cite_ref-PM21494025_6-0" class="reference"> ***a href="#cite_note-PM21494025-6">[6] ***/a> ***/sup>. Simplifying, SN can show, demoscopically, three main patterns: a starburst pattern, a vascular pattern with regularly distributed dotted vessels and a globular pattern with reticular depigmentation. ***/p> ***h3> ***span class="mw-headline" id="Non_pigmented_Spitz_nevus">Non pigmented Spitz nevus ***/span> ***/h3> ***p>The dermoscopic hallmark of non pigmented Spitz nevus is the vascular pattern, detectable as dotted vessels (Figure 1), monomorphic and uniformly distributed throughout the lesion. In raised or nodular Spitz nevi, the vessels might not appear as small dots, but as larger red globules, twisted (spiral), hairpin or corkscrew vessels, nevertheless their distribution is symmetric. When vascular structures are asymmetrically distributed, or there is brownish color and tan/brown globules within lesion, the lesion is more suggestive for melanoma8. Another frequent additional feature of non pigmented SN is reticular depigmentation (Figure 2) visible either as a negative network (a whitish grid surrounding the vessels), or as chrysalis-like structures (shiny white lines that are often oriented orthogonally or in parallel to each other). Moreover, while negative network can be visualized with both polarized and no polarized dermoscopy, crystalline structures can be seen only with polarized light ***sup id="cite_ref-7" class="reference"> ***a href="#cite_note-7">[7] ***/a> ***/sup> ***sup id="cite_ref-PM24075543_4-1" class="reference"> ***a href="#cite_note-PM24075543-4">[4] ***/a> ***/sup>. The differential diagnosis of non pigmented SN includes a series of no melanocytic lesions such as pyogenic granuloma, hemangioma, solitary mastocitoma, juvenile xantogranuloma, lymphoid infiltration of the skin, angiolymphoid hyperplasia with eosinophilia, dermatofibroma and viral wart. ***/p> ***p>At histology, they show a melanocytic proliferation, polygonal or cigar-shaped, with large nuclei, prominent nucleoli, and abundant ground-glass cytoplasm. Large and coalescent eosinophilic bodies (Kamino) at dermo-epidermal junction, edema, teleangectasias and fibrosis of the papillary dermis and melanin within spindle cells and dermal melanophages are also frequently seen ***sup id="cite_ref-PM16301385_2-1" class="reference"> ***a href="#cite_note-PM16301385-2">[2] ***/a> ***/sup> ***sup id="cite_ref-PM19318795_8-0" class="reference"> ***a href="#cite_note-PM19318795-8">[8] ***/a> ***/sup>. ***/p> ***p> ***br /> ***/p> ***div style="float: left; margin: 0 2em;"> ***div class="image100"> ***a href="https://dermoscopedia.org/File:Fig._5_Reed_Spitz_Nevi.jpg" class="image" title="Figure 1: Amelanotic Spitz nevus with a pink background and dotted vessels regularly distributed."> ***img alt="Figure 1: Amelanotic Spitz nevus with a pink background and dotted vessels regularly distributed." src="https://dermoscopedia.org/w/images/2/22/Fig._5_Reed_Spitz_Nevi.jpg" decoding="async" width="1200" height="1173" data-file-width="663" data-file-height="648" /> ***/a> ***br /> ***b>Figure 1: Amelanotic Spitz nevus with a pink background and dotted vessels regularly distributed. ***/b> ***/div> ***/div> ***div style="clear:both;"> ***/div> ***p> ***br /> ***/p> ***div style="float: left; margin: 0 2em;"> ***div class="image100"> ***a href="https://dermoscopedia.org/File:Fig._7_Reed_Spitz_Nevi.jpg" class="image" title="Figure 2: A hypopigmented lesion of a young boy showing at dermoscopy, negative network, dotted vessels and brown pigmentation."> ***img alt="Figure 2: A hypopigmented lesion of a young boy showing at dermoscopy, negative network, dotted vessels and brown pigmentation." src="https://dermoscopedia.org/w/images/a/ad/Fig._7_Reed_Spitz_Nevi.jpg" decoding="async" width="1200" height="1345" data-file-width="514" data-file-height="576" /> ***/a> ***br /> ***b>Figure 2: A hypopigmented lesion of a young boy showing at dermoscopy, negative network, dotted vessels and brown pigmentation. ***/b> ***/div> ***/div> ***div style="clear:both;"> ***/div> ***h3> ***span class="mw-headline" id="Pigmented_Spitz_nevus">Pigmented Spitz nevus ***/span> ***/h3> ***p>Pigmented SN could show a globular, starburst, reticular, atypical or homogeneous pattern dermoscopically ***sup id="cite_ref-PM22082838_9-0" class="reference"> ***a href="#cite_note-PM22082838-9">[9] ***/a> ***/sup> ***sup id="cite_ref-PM20145536_10-0" class="reference"> ***a href="#cite_note-PM20145536-10">[10] ***/a> ***/sup> ***sup id="cite_ref-PM27222770_11-0" class="reference"> ***a href="#cite_note-PM27222770-11">[11] ***/a> ***/sup> ***sup id="cite_ref-12" class="reference"> ***a href="#cite_note-12">[12] ***/a> ***/sup>. The globular pattern, presents in about 20% of SN, consists of gray-brown to blue globules generally distributed throughout the lesion or mostly at the periphery. A starburst aspect is possible if the peripheral globules are merging with the central body of the lesion. The globular pattern of Spitz nevi differs from the globular pattern seen in growing Clark nevi, because the peripheral globules are distributed in a single row for the latter, while in multiple rows for SN (Fig. 3). ***/p> ***p> ***br /> ***/p> ***div style="float: left; margin: 0 2em;"> ***div class="image100"> ***a href="https://dermoscopedia.org/File:Fig._9_Reed_Spitz_Nevi.jpg" class="image" title="Figure 3: A pigmented SN with globular pattern."> ***img alt="Figure 3: A pigmented SN with globular pattern." src="https://dermoscopedia.org/w/images/3/3c/Fig._9_Reed_Spitz_Nevi.jpg" decoding="async" width="1200" height="1173" data-file-width="663" data-file-height="648" /> ***/a> ***br /> ***b>Figure 3: A pigmented SN with globular pattern. ***/b> ***/div> ***/div> ***div style="clear:both;"> ***/div> ***p>The starburst pattern, indicating the radial growth phase of the tumor, consists of a central homogenous black-blue pigmentation surrounded by streaks, pseudopods or finger-like projection regularly and symmetrically distributed at periphery (Fig. 4). ***/p> ***p> ***br /> ***/p> ***div style="float: left; margin: 0 2em;"> ***div class="image100"> ***a href="https://dermoscopedia.org/File:Fig._2_Reed_Spitz_Nevi.jpg" class="image" title="Figure 4: A small hyperpigmented SN showing at periphery regular streaks."> ***img alt="Figure 4: A small hyperpigmented SN showing at periphery regular streaks." src="https://dermoscopedia.org/w/images/8/80/Fig._2_Reed_Spitz_Nevi.jpg" decoding="async" width="1200" height="1531" data-file-width="453" data-file-height="578" /> ***/a> ***br /> ***b>Figure 4: A small hyperpigmented SN showing at periphery regular streaks. ***/b> ***/div> ***/div> ***div style="clear:both;"> ***/div> ***p>Heavily pigmented Spitz nevi are predominant in children under 12 years of age. They often exhibit a reticular pattern well visible at the periphery and a central black lamella due to excessive amounts of melanin in the stratum corneum (Fig. 5). The tape stripping removes the black lamella, but not the pigmented network. ***/p> ***p> ***br /> ***/p> ***div style="float: left; margin: 0 2em;"> ***div class="image100"> ***a href="https://dermoscopedia.org/File:Fig._6_Reed_Spitz_Nevi.jpg" class="image" title="Figure 5: A pigmented SN with reticular pattern."> ***img alt="Figure 5: A pigmented SN with reticular pattern." src="https://dermoscopedia.org/w/images/f/fe/Fig._6_Reed_Spitz_Nevi.jpg" decoding="async" width="1200" height="1327" data-file-width="586" data-file-height="648" /> ***/a> ***br /> ***b>Figure 5: A pigmented SN with reticular pattern. ***/b> ***/div> ***/div> ***div style="clear:both;"> ***/div> ***p>SN with atypical multicomponent dermoscopic pattern have a “melanoma like” appearance and are characterized, by atypical pigment network, irregular dots and globules, irregular pigmentation and irregular streaks (Fig. 6). These features can be also simultaneously present and associated with blue-whitish veil. These SN are very difficult to differentiate clinically, dermoscopically and histopathologically from melanoma. ***/p> ***p> ***br /> ***/p> ***div style="float: left; margin: 0 2em;"> ***div class="image100"> ***a href="https://dermoscopedia.org/File:Fig._8_Reed_Spitz_Nevi.jpg" class="image" title="Figure 6: A SN with atypical pattern for asymmetry and multiple colors. This lesion is able to simulate a melanoma."> ***img alt="Figure 6: A SN with atypical pattern for asymmetry and multiple colors. This lesion is able to simulate a melanoma." src="https://dermoscopedia.org/w/images/b/b2/Fig._8_Reed_Spitz_Nevi.jpg" decoding="async" width="1200" height="1173" data-file-width="663" data-file-height="648" /> ***/a> ***br /> ***b>Figure 6: A SN with atypical pattern for asymmetry and multiple colors. This lesion is able to simulate a melanoma. ***/b> ***/div> ***/div> ***div style="clear:both;"> ***/div> ***p>Black Spitz nevi could show at dermoscopy also a homogenous pattern with only a dark brown to black–bluish color without any other dermoscopic structure (Fig.7). The homogenous and reticular patterns have been suggested to represent the later evolution phases of the starburst pattern; in fact, they are more frequent among older patients. ***/p> ***p>At histology, pigmented SN present as heavily pigmented lesions, with cohesive spindle and/or epithelioid melanocytes, parallel and perpendicular to the skin surface. ***/p> ***p> ***br /> ***/p> ***div style="float: left; margin: 0 2em;"> ***div class="image100"> ***a href="https://dermoscopedia.org/File:Fig._4_Reed_Spitz_Nevi.jpg" class="image" title="Figure 7: This structureless lesion show a homogenous pattern characterized by a dark brown to black-bluish color."> ***img alt="Figure 7: This structureless lesion show a homogenous pattern characterized by a dark brown to black-bluish color." src="https://dermoscopedia.org/w/images/3/38/Fig._4_Reed_Spitz_Nevi.jpg" decoding="async" width="1200" height="1173" data-file-width="663" data-file-height="648" /> ***/a> ***br /> ***b>Figure 7: This structureless lesion show a homogenous pattern characterized by a dark brown to black-bluish color. ***/b> ***/div> ***/div> ***div style="clear:both;"> ***/div> ***h2> ***span class="mw-headline" id="Natural_evolution_of_Spitz_nevi">Natural evolution of Spitz nevi ***/span> ***/h2> ***p>The starburst, globular and atypical patterns are the most common morphologic variants of SN and correspond to the different phases of the natural evolution of Spitz nevi. At beginning, pigmented Spitz nevi show a globular pattern and, after a variable number of months, a starburst pattern. Differently from melanoma, in SN the peripheral projections disappear over time and the lesion becomes stable thus showing a homogeneous pattern. The progressive decrease of pigmentation or the complete involution of the lesion are the last evolution stages for a pigmented SN. The same behavior is also seen in amelanotic or hypopigmented SN; indeed, after a growing phase of several months they start to involve until final disappearance ***sup id="cite_ref-PM12074862_5-1" class="reference"> ***a href="#cite_note-PM12074862-5">[5] ***/a> ***/sup> ***sup id="cite_ref-PM21494025_6-1" class="reference"> ***a href="#cite_note-PM21494025-6">[6] ***/a> ***/sup> (Fig. 8). ***/p> ***p> ***br /> ***/p> ***div style="float: left; margin: 0 2em;"> ***div class="image100"> ***a href="https://dermoscopedia.org/File:Fig._3_Reed_Spitz_Nevi.jpg" class="image" title="Figure 8: The process of involution of a SN after a follow-up period of 38 months."> ***img alt="Figure 8: The process of involution of a SN after a follow-up period of 38 months." src="https://dermoscopedia.org/w/images/0/05/Fig._3_Reed_Spitz_Nevi.jpg" decoding="async" width="1200" height="604" data-file-width="898" data-file-height="452" /> ***/a> ***br /> ***b>Figure 8: The process of involution of a SN after a follow-up period of 38 months. ***/b> ***/div> ***/div> ***div style="clear:both;"> ***/div> ***h2> ***span class="mw-headline" id="Diagnosis_and_Management">Diagnosis and Management ***/span> ***/h2> ***p>The diagnosis and management of patients with Spitz nevi could be difficult, above all because most cases of atypical Spitz nevi cannot be differentiated from melanoma. Some authors have proposed a conservative management in children based on the evidence that SN are very common at this age whereas melanoma is very rare. In children under 12 years of age with a classic or pigmented small (up to 1 cm) SN without asymmetry or atypical features, it is advisable to monitor the lesion every 6 months. If the lesion does not show irregular changes in shape, size and color over the time, a 1 year follow up can continue until the lesion stabilization or involution. ***/p> ***p>When Spitz nevi appear in children older than 12 years and in adult, surgical excision is always recommended because it is really hard to make a difference with spitzoid melanoma. ***/p> ***p>As a rule all spitzoid lesion resulting to be nodular, ulcerated, atypical or rapidly growing have to be excised irrespective of age ***sup id="cite_ref-PM28118479_13-0" class="reference"> ***a href="#cite_note-PM28118479-13">[13] ***/a> ***/sup> ***sup id="cite_ref-PM22428965_14-0" class="reference"> ***a href="#cite_note-PM22428965-14">[14] ***/a> ***/sup> ***sup id="cite_ref-PM15857482_15-0" class="reference"> ***a href="#cite_note-PM15857482-15">[15] ***/a> ***/sup>. ***/p> ***div style="max-width:400px"> ***p> ***div class="videoWrapper"> ***iframe width="400" height="300" src="https://www.youtube.com/embed/vR8lHUN7elk" frameborder="0" allowfullscreen> ***/iframe> ***/div> ***br /> ***/p> ***/div> ***p> ***br /> ***br /> ***/p> ***div style="font-size: 1.8rem; border-bottom: 1px solid #a2a9b1; width: 100%">References ***/div> ***div class="mw-references-wrap mw-references-columns"> ***ol class="references"> ***li id="cite_note-PM18859360-1"> ***span class="mw-cite-backlink"> ***a href="#cite_ref-PM18859360_1-0">↑ ***/a> ***/span> ***span class="reference-text">SPITZ: Melanomas of childhood. ***i>Am. 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Color Atlas of Melanocytic Lesions of the Skin. Berlin-Heidelberg: Springer-Verlag, 2007: 151-63 ***/span> ***/li> ***li id="cite_note-PM19318795-8"> ***span class="mw-cite-backlink"> ***a href="#cite_ref-PM19318795_8-0">↑ ***/a> ***/span> ***span class="reference-text">Requena ***i>et al. ***/i>: Spitz nevus: a clinicopathological study of 349 cases. ***i>Am J Dermatopathol ***/i> 2009;31:107-16. PMID:  ***a class="external text" href="https://www.ncbi.nlm.nih.gov/pubmed/19318795">19318795 ***/a>. ***a class="external text" href="https://dx.doi.org/10.1097/DAD.0b013e3181934218">DOI ***/a>. ***/span> ***/li> ***li id="cite_note-PM22082838-9"> ***span class="mw-cite-backlink"> ***a href="#cite_ref-PM22082838_9-0">↑ ***/a> ***/span> ***span class="reference-text">Luo ***i>et al. ***/i>: Spitz nevi and other Spitzoid lesions part I. Background and diagnoses. ***i>J. Am. Acad. Dermatol. ***/i> 2011;65:1073-84. PMID:  ***a class="external text" href="https://www.ncbi.nlm.nih.gov/pubmed/22082838">22082838 ***/a>. ***a class="external text" href="https://dx.doi.org/10.1016/j.jaad.2011.04.040">DOI ***/a>. ***/span> ***/li> ***li id="cite_note-PM20145536-10"> ***span class="mw-cite-backlink"> ***a href="#cite_ref-PM20145536_10-0">↑ ***/a> ***/span> ***span class="reference-text">Ferrara ***i>et al. ***/i>: Spitz nevus: an evolving clinicopathologic concept. ***i>Am J Dermatopathol ***/i> 2010;32:410-4. PMID:  ***a class="external text" href="https://www.ncbi.nlm.nih.gov/pubmed/20145536">20145536 ***/a>. ***a class="external text" href="https://dx.doi.org/10.1097/DAD.0b013e3181b6aab4">DOI ***/a>. ***/span> ***/li> ***li id="cite_note-PM27222770-11"> ***span class="mw-cite-backlink"> ***a href="#cite_ref-PM27222770_11-0">↑ ***/a> ***/span> ***span class="reference-text">Pedrosa ***i>et al. ***/i>: Spitz/Reed nevi: a review of clinical-dermatoscopic and histological correlation. ***i>Dermatol Pract Concept ***/i> 2016;6:37-41. PMID:  ***a class="external text" href="https://www.ncbi.nlm.nih.gov/pubmed/27222770">27222770 ***/a>. ***a class="external text" href="https://dx.doi.org/10.5826/dpc.0602a07">DOI ***/a>. ***/span> ***/li> ***li id="cite_note-12"> ***span class="mw-cite-backlink"> ***a href="#cite_ref-12">↑ ***/a> ***/span> ***span class="reference-text">Argenziano G, Soyer HP, Ferrara G et al. Superficial Black network: an additional dermoscopic clue for the diagnosis of pigmented spindle and/or epithelioid cell nevus. Dermatology (Basel) 2001; 203:333-5 ***/span> ***/li> ***li id="cite_note-PM28118479-13"> ***span class="mw-cite-backlink"> ***a href="#cite_ref-PM28118479_13-0">↑ ***/a> ***/span> ***span class="reference-text">Lallas ***i>et al. ***/i>: Update on dermoscopy of Spitz/Reed naevi and management guidelines by the International Dermoscopy Society. ***i>Br. J. Dermatol. ***/i> 2017;. PMID:  ***a class="external text" href="https://www.ncbi.nlm.nih.gov/pubmed/28118479">28118479 ***/a>. ***a class="external text" href="https://dx.doi.org/10.1111/bjd.15339">DOI ***/a>. ***/span> ***/li> ***li id="cite_note-PM22428965-14"> ***span class="mw-cite-backlink"> ***a href="#cite_ref-PM22428965_14-0">↑ ***/a> ***/span> ***span class="reference-text">Moscarella ***i>et al. ***/i>: Excised melanocytic lesions in children and adolescents - a 10-year survey. ***i>Br. J. Dermatol. ***/i> 2012;167:368-73. PMID:  ***a class="external text" href="https://www.ncbi.nlm.nih.gov/pubmed/22428965">22428965 ***/a>. ***a class="external text" href="https://dx.doi.org/10.1111/j.1365-2133.2012.10952.x">DOI ***/a>. ***/span> ***/li> ***li id="cite_note-PM15857482-15"> ***span class="mw-cite-backlink"> ***a href="#cite_ref-PM15857482_15-0">↑ ***/a> ***/span> ***span class="reference-text">Brunetti ***i>et al. ***/i>: Spitz naevus: a proposal for management. ***i>J Eur Acad Dermatol Venereol ***/i> 2005;19:391-3. PMID:  ***a class="external text" href="https://www.ncbi.nlm.nih.gov/pubmed/15857482">15857482 ***/a>. ***a class="external text" href="https://dx.doi.org/10.1111/j.1468-3083.2004.01137.x">DOI ***/a>. ***/span> ***/li> ***/ol> ***/div> ***div style="clear:both;"> ***/div> ***!-- NewPP limit report Cached time: 20240908115611 Cache expiry: 0 Dynamic content: true Complications: [] [SMW] In‐text annotation parser time: 0.003 seconds CPU time usage: 0.280 seconds Real time usage: 0.338 seconds Preprocessor visited node count: 1640/1000000 Post‐expand include size: 21036/3145728 bytes Template argument size: 6021/3145728 bytes Highest expansion depth: 8/50 Expensive parser function count: 0/100 Unstrip recursion depth: 0/20 Unstrip post‐expand size: 11102/5000000 bytes --> ***!-- Transclusion expansion time report (%,ms,calls,template) 100.00% 304.239 1 -total 67.41% 205.092 1 Template:Page 15.53% 47.257 16 Template:PubMed 5.58% 16.966 8 Template:File 5.28% 16.064 2 Template:YouTube 4.49% 13.650 1 Template:H2 4.12% 12.539 1 Template:PageTOC 3.55% 10.798 1 Template:LinkToAskQueryForPageOwner 1.61% 4.888 1 Template:MetaElements 1.13% 3.432 12 Template:Pubmed --> ***/div>

***div class="mw-parser-output"> ***div style="display: none"> ***p> ***a href= "https://dermoscopedia.org/Glossary:Hair" title="Glossary:Hair">Hair ***/a>, ***a href= "https://dermoscopedia.org/Glossary:Dermoscopy" title="Glossary:Dermoscopy">Dermoscopy ***/a>, ***a href= "https://dermoscopedia.org/Glossary:Trichoscopy" title="Glossary:Trichoscopy">Trichoscopy ***/a>, ***a href= "https://dermoscopedia.org/Glossary:Follicle_openings" title="Glossary:Follicle openings">Follicle openings ***/a> ***a href= "https://dermoscopedia.org/Cite:Hair_follicle_openings" title="Cite:Hair follicle openings">Hair follicle openings – cite! ***/a> ***a href= "https://dermoscopedia.org/Message:Hair_follicle_openings" title="Message:Hair follicle openings">Hair follicle openings (message) ***/a> ***a href= "https://dermoscopedia.org/Participate:Hair_follicle_openings" title="Participate:Hair follicle openings">Hair follicle openings – participate! ***/a> ***/p> ***div style="display: none"> User= ***/div> ***/div> ***p>"Dots" correspond to hair follicle openings observed in trichoscopic examination [1]. ***br /> ***br /> ***/p> ***p> ***br /> ***/p> ***div id="toc" class="toc" role="navigation" aria-labelledby="mw-toc-heading"> ***input type="checkbox" role="button" id="toctogglecheckbox" class="toctogglecheckbox" style="display:none" /> ***div class="toctitle" lang="en" dir="ltr"> ***h2 id="mw-toc-heading">Contents ***/h2> ***span class="toctogglespan"> ***label class="toctogglelabel" for="toctogglecheckbox"> ***/label> ***/span> ***/div> ***ul> ***li class="toclevel-1 tocsection-1"> ***a href="#Black_dots"> ***span class="tocnumber">1 ***/span> ***span class="toctext">Black dots ***/span> ***/a> ***/li> ***li class="toclevel-1 tocsection-2"> ***a href="#Yellow_dots"> ***span class="tocnumber">2 ***/span> ***span class="toctext">Yellow dots ***/span> ***/a> ***/li> ***li class="toclevel-1 tocsection-3"> ***a href="#Red_dots"> ***span class="tocnumber">3 ***/span> ***span class="toctext">Red dots ***/span> ***/a> ***/li> ***li class="toclevel-1 tocsection-4"> ***a href="#White_dots"> ***span class="tocnumber">4 ***/span> ***span class="toctext">White dots ***/span> ***/a> ***/li> ***/ul> ***/div> ***h3> ***span class="mw-headline" id="Black_dots">Black dots ***/span> ***/h3> ***p>Black dots, also known as “%%%mot_cle%%%”, represent pigmented hairs broken or destroyed at scalp level [1]. They are commonly observed in alopecia areata [3], dissecting cellulitis [4, 5], trichotillomania [6] and tinea capitis [4]. Black dots may be also detected in chemotherapy-induced alopecia [4], lichen planopilaris [7], discoid lupus erythematosus [7], traction ***br /> ***br /> ***/p> ***h3> ***span class="mw-headline" id="Yellow_dots">Yellow dots ***/span> ***/h3> ***p>Yellow dots correspond to follicular infundibula filled with sebum and/or keratotic material [10]. They present as yellow, or whitish, round or polycyclic dots, varied in size and uniformed in color, devoid of hairs or containing miniaturized, cadaverized or dystrophic hairs [10-12]. ***br /> In alopecia areata, yellow dots are characterized by an abundant amount and regular distribution and predominate in long-lasting, inactive disease [3, 13]. ***br /> The predominance of yellow dots (they are predominantly sebaceous) in the frontal area compared to the occipital area is characteristic for androgenetic alopecia [14]. They correspond to empty follicular openings of follicles in kenogen phase. ***br /> In discoid lupus erythematosus, large, dark yellow dots that correspond to wide infundibula filled with keratotic material are observed [1, 5]. ***br /> Yellow dots, appearing as large "3D" soap bubbles imposed over dark dystrophic hairs are specific for dissecting cellulitis [1, 5]. ***br /> Sparse yellow dots may also be detected in chronic telogen effluvium [8, 9], traumatic alopecia [8] traction alopecia [7], congenital hypotrichoses and kerion celsi [15]. ***br /> ***br /> ***/p> ***h3> ***span class="mw-headline" id="Red_dots">Red dots ***/span> ***/h3> ***p>Red dots correspond to widened infundibula plugged by keratin and surrounded by dilated vessels and extravasated erythrocytes [16]. They are characteristic trichoscopic finding for active discoid lupus erythematosus and believed to be a positive prognostic factor [5]. ***br /> ***br /> ***/p> ***p> ***br /> ***/p> ***h3> ***span class="mw-headline" id="White_dots">White dots ***/span> ***/h3> ***p>There are two types of white dots. ***br /> The classic, big, irregular white dots correspond to areas of perifollicular fibrosis and are observed most commonly in lichen planopilaris [1]. ***br /> The small, regular pinpoint white dots represent hair follicle openings and eccrine sweat gland openings and are observed in sun exposed areas and in dark skin phototypes regardless of hair loss [1]. ***/p> ***!-- NewPP limit report Cached time: 20240908115612 Cache expiry: 0 Dynamic content: true Complications: [] [SMW] In‐text annotation parser time: 0.005 seconds CPU time usage: 0.213 seconds Real time usage: 0.255 seconds Preprocessor visited node count: 413/1000000 Post‐expand include size: 6914/3145728 bytes Template argument size: 478/3145728 bytes Highest expansion depth: 7/50 Expensive parser function count: 0/100 Unstrip recursion depth: 0/20 Unstrip post‐expand size: 2037/5000000 bytes --> ***!-- Transclusion expansion time report (%,ms,calls,template) 100.00% 229.819 1 Template:Page 100.00% 229.819 1 -total 5.50% 12.639 1 Template:LinkToAskQueryForPageOwner 3.32% 7.628 1 Template:MetaElements 1.08% 2.476 1 Template:Clear --> ***/div>

***div class="mw-parser-output"> ***div style="display: none"> ***p> ***a href= "https://dermoscopedia.org/Glossary:Solar_lentigines" title="Glossary:%%%mot_cle%%%">%%%mot_cle%%% ***/a>, ***a href= "https://dermoscopedia.org/Glossary:Moth-eaten_border" title="Glossary:Moth-eaten border">Moth-eaten border ***/a>, ***a href= "https://dermoscopedia.org/Glossary:Pigment_network" title="Glossary:Pigment network">Pigment network ***/a>, ***a href= "https://dermoscopedia.org/Glossary:Pseudonetwork" title="Glossary:Pseudonetwork">Pseudonetwork ***/a>, ***a href= "https://dermoscopedia.org/Glossary:Symmetric_brown_follicular_pigmentation" title="Glossary:Symmetric brown follicular pigmentation">Symmetric brown follicular pigmentation ***/a>, ***a href= "https://dermoscopedia.org/Glossary:Homogeneous_light_brown_pigmentation" title="Glossary:Homogeneous light brown pigmentation">Homogeneous light brown pigmentation ***/a> ***a href= "https://dermoscopedia.org/Cite:Solar_lentigines" title="Cite:%%%mot_cle%%%">%%%mot_cle%%% – cite! ***/a> ***a href= "https://dermoscopedia.org/Message:Solar_lentigines" title="Message:%%%mot_cle%%%">%%%mot_cle%%% (message) ***/a> ***a href= "https://dermoscopedia.org/Participate:Solar_lentigines" title="Participate:%%%mot_cle%%%">%%%mot_cle%%% – participate! ***/a> ***/p> ***div style="display: none"> User= ***/div> ***/div> ***p>%%%mot_cle%%% are sharply circumscribed, uniformly pigmented macules that are located predominantly on the sun-exposed areas of the skin, such as the dorsum of the hands, the shoulders, and the scalp. Lentigines are a result of hyperplasia of keratinocytes and melanocytes, with increased accumulation of melanin in the keratinocytes. They are induced by ultraviolet light exposure. ***/p> ***p>Unlike freckles, solar lentigines persist indefinitely. Nearly 90% of Caucasians over the age of 60 years have these lesions. Due to the increased prevalence of lentigines in the elderly, these lesions are sometimes referred to as “lentigo senilis”. However, younger individuals who tend to burn after ultraviolet exposure can also develop lentigines after acute or prolonged ultraviolet light exposure. Clinically, solar lentigines may be oval, round, or irregular in shape and can vary from a few millimeters to a few centimeters in diameter. Most lesions have a uniform light brown color; however, there are instances when they vary from dark brown to black. One variant of solar lentigo, “ink-spot” lentigo, has a jet-black color. Actinic purpura or other signs of solar damage can frequently be found in the skin surrounding solar lentigines. %%%mot_cle%%% are benign lesions that can evolve to a pigmented seborrheic keratosis. Histologically, it is characterized by club-shaped rete ridges with small nub-like extensions. In addition, there is an increased number of melanocytes and increased pigmentation in the basal keratinocytes. Although most solar lentigines are easily recognized on clinical examination, some lesions pose diagnostic challenges because their clinical appearance resembles that of melanoma. Dermoscopy can be helpful in correctly differentiating a solar lentigo from melanoma. The key dermoscopic features of solar lentigines are as follows: ***/p> ***div id="toc" class="toc" role="navigation" aria-labelledby="mw-toc-heading"> ***input type="checkbox" role="button" id="toctogglecheckbox" class="toctogglecheckbox" style="display:none" /> ***div class="toctitle" lang="en" dir="ltr"> ***h2 id="mw-toc-heading">Contents ***/h2> ***span class="toctogglespan"> ***label class="toctogglelabel" for="toctogglecheckbox"> ***/label> ***/span> ***/div> ***ul> ***li class="toclevel-1 tocsection-1"> ***a href="#Moth-eaten_border"> ***span class="tocnumber">1 ***/span> ***span class="toctext">Moth-eaten border ***/span> ***/a> ***/li> ***li class="toclevel-1 tocsection-2"> ***a href="#Homogenous_light_brown_pigmentation"> ***span class="tocnumber">2 ***/span> ***span class="toctext">Homogenous light brown pigmentation ***/span> ***/a> ***/li> ***li class="toclevel-1 tocsection-3"> ***a href="#Pigment_network_.28Network_like_structures.29"> ***span class="tocnumber">3 ***/span> ***span class="toctext">Pigment network (Network like structures) ***/span> ***/a> ***/li> ***li class="toclevel-1 tocsection-4"> ***a href="#Fingerprint-like_areas"> ***span class="tocnumber">4 ***/span> ***span class="toctext">Fingerprint-like areas ***/span> ***/a> ***/li> ***li class="toclevel-1 tocsection-5"> ***a href="#Pseudonetwork"> ***span class="tocnumber">5 ***/span> ***span class="toctext">Pseudonetwork ***/span> ***/a> ***/li> ***li class="toclevel-1 tocsection-6"> ***a href="#Symmetric_brown_follicular_pigmentation"> ***span class="tocnumber">6 ***/span> ***span class="toctext">Symmetric brown follicular pigmentation ***/span> ***/a> ***/li> ***li class="toclevel-1 tocsection-7"> ***a href="#Ink-sport_lentigo"> ***span class="tocnumber">7 ***/span> ***span class="toctext">Ink-sport lentigo ***/span> ***/a> ***/li> ***/ul> ***/div> ***h2> ***span class="mw-headline" id="Moth-eaten_border">Moth-eaten border ***/span> ***/h2> ***p>The presence of a sharply demarcated and irregularly curved border is characteristic of solar lentigines. Often, portions of the border are scalloped, giving a motheaten appearance ***br /> ***/p> ***div class="center"> ***div class="floatnone"> ***a href="https://dermoscopedia.org/File:Moth_eaten.jpg" class="image"> ***img alt="Moth eaten.jpg" src="https://dermoscopedia.org/w/thumb.php?f=Moth_eaten.jpg&width=600" decoding="async" width="600" height="399" class="img-fluid" srcset="https://dermoscopedia.org/w/thumb.php?f=Moth_eaten.jpg&width=900 1.5x, https://dermoscopedia.org/w/thumb.php?f=Moth_eaten.jpg&width=1200 2x" data-file-width="3008" data-file-height="2000" /> ***/a> ***/div> ***/div> ***div style="clear:both;"> ***/div> ***h2> ***span class="mw-headline" id="Homogenous_light_brown_pigmentation">Homogenous light brown pigmentation ***/span> ***/h2> ***p>Many lesions have no structures or networks, only containing light brown and structureless areas; the term “jelly sign” had been proposed to describe the pigment quality of these lesions. The pigment appears as if jelly had been smeared on the skin surface. ***br /> ***/p> ***div class="center"> ***div class="floatnone"> ***a href="https://dermoscopedia.org/File:Homogenous_light_pigmented_SL.jpg" class="image"> ***img alt="Homogenous light pigmented SL.jpg" src="https://dermoscopedia.org/w/thumb.php?f=Homogenous_light_pigmented_SL.jpg&width=600" decoding="async" width="600" height="399" class="img-fluid" srcset="https://dermoscopedia.org/w/thumb.php?f=Homogenous_light_pigmented_SL.jpg&width=900 1.5x, https://dermoscopedia.org/w/thumb.php?f=Homogenous_light_pigmented_SL.jpg&width=1200 2x" data-file-width="4288" data-file-height="2848" /> ***/a> ***/div> ***/div> ***h2> ***span id="Pigment_network_(Network_like_structures)"> ***/span> ***span class="mw-headline" id="Pigment_network_.28Network_like_structures.29">Pigment network (Network like structures) ***/span> ***/h2> ***p>There may be an area of faint, reticulation. This correlates with the presence of melanocytes and melanin-filled keratinocytes in the rete ridges. ***/p> ***div class="center"> ***div class="thumb tnone"> ***div class="thumbinner" style="width:602px;"> ***a href="https://dermoscopedia.org/File:SL_1.jpg" class="image"> ***img alt="" src="https://dermoscopedia.org/w/thumb.php?f=SL_1.jpg&width=600" decoding="async" width="600" height="450" class="thumbimage" srcset="https://dermoscopedia.org/w/thumb.php?f=SL_1.jpg&width=900 1.5x, https://dermoscopedia.org/w/images/1/18/SL_1.jpg 2x" data-file-width="1024" data-file-height="768" /> ***/a> ***div class="thumbcaption"> ***div class="magnify"> ***a href="https://dermoscopedia.org/File:SL_1.jpg" class="internal" title="Enlarge"> ***/a> ***/div>A solar lentigo with pigment network and some finger print-like areas (see below) ***/div> ***/div> ***/div> ***/div> ***div style="clear:both;"> ***/div> ***h2> ***span class="mw-headline" id="Fingerprint-like_areas">Fingerprint-like areas ***/span> ***/h2> ***p>They are areas consisting of fine parallel running lines of light brown to dark brown colors. They resemble the dermatoglyphics of a human fingerprint. ***/p> ***div class="center"> ***div class="floatnone"> ***a href="https://dermoscopedia.org/File:Untitled_Artwork_24.jpg" class="image"> ***img alt="Untitled Artwork 24.jpg" src="https://dermoscopedia.org/w/thumb.php?f=Untitled_Artwork_24.jpg&width=600" decoding="async" width="600" height="450" class="img-fluid" srcset="https://dermoscopedia.org/w/thumb.php?f=Untitled_Artwork_24.jpg&width=900 1.5x, https://dermoscopedia.org/w/thumb.php?f=Untitled_Artwork_24.jpg&width=1200 2x" data-file-width="2732" data-file-height="2048" /> ***/a> ***/div> ***/div> ***h2> ***span class="mw-headline" id="Pseudonetwork">Pseudonetwork ***/span> ***/h2> ***p>Lentigines located on the scalp and face share features of pigmented melanocytic lesions in this special location revealing a pseudonetwork pattern. This is created when a diffusely pigmented area is interrupted by nonpigmented adnexal openings . ***/p> ***h2> ***span class="mw-headline" id="Symmetric_brown_follicular_pigmentation">Symmetric brown follicular pigmentation ***/span> ***/h2> ***p>In a solar lentigo the pigment around hair follicles is distributed in a symmetric fashion creating small brown circles. The pigment is usually light brown in color and similar to the color of the rest of the lesion. While the pigment is usually distributed symmetrically around the follicle, some follicles may appear asymmetrically pigmented. These asymmetrically pigmented follicles appear as brown crescent shaped structures. However, these asymmetric follicles will also have a brown color like the rest of the lesion. If the color of the pigment around the follicle, whether symmetric or asymmetric, is of a grayish hue or differs from the rest of the lesion then melanoma needs to enter the differential diagnosis. ***br /> ***/p> ***h2> ***span class="mw-headline" id="Ink-sport_lentigo">Ink-sport lentigo ***/span> ***/h2> ***p>Ink-spot lentigines have their own distinct dermoscopic pattern.These lesions have a very prominent blackpigmented network, which has an almost three-dimensional quality under dermoscopy. The network lines can be either thin or thick in width, and the network ends abruptly at the edge of the lesion ***/p> ***!-- NewPP limit report Cached time: 20240908115613 Cache expiry: 0 Dynamic content: true Complications: [] [SMW] In‐text annotation parser time: 0.003 seconds CPU time usage: 0.154 seconds Real time usage: 0.185 seconds Preprocessor visited node count: 438/1000000 Post‐expand include size: 6409/3145728 bytes Template argument size: 457/3145728 bytes Highest expansion depth: 7/50 Expensive parser function count: 0/100 Unstrip recursion depth: 0/20 Unstrip post‐expand size: 2347/5000000 bytes --> ***!-- Transclusion expansion time report (%,ms,calls,template) 100.00% 162.191 1 -total 99.85% 161.942 1 Template:Page 3.11% 5.051 1 Template:LinkToAskQueryForPageOwner 2.92% 4.729 1 Template:MetaElements 1.33% 2.156 3 Template:Clear --> ***/div>

***div class="mw-parser-output"> ***div style="display: none"> ***p> ***a href= "https://dermoscopedia.org/Glossary:Trichoscopy" title="Glossary:Trichoscopy">Trichoscopy ***/a>, ***a href= "https://dermoscopedia.org/Glossary:Dermoscopy" title="Glossary:Dermoscopy">Dermoscopy ***/a>, ***a href= "https://dermoscopedia.org/Glossary:Alopecia_areata" title="Glossary:Alopecia areata">Alopecia areata ***/a> ***a href= "https://dermoscopedia.org/Cite:Alopecia_areata" title="Cite:Alopecia areata">Alopecia areata – cite! ***/a> ***a href= "https://dermoscopedia.org/Message:Alopecia_areata" title="Message:Alopecia areata">Alopecia areata (message) ***/a> ***a href= "https://dermoscopedia.org/Participate:Alopecia_areata" title="Participate:Alopecia areata">Alopecia areata – participate! ***/a> ***/p> ***div style="display: none"> User= ***/div> ***/div> ***p>Trichoscopic findings of %%%mot_cle%%% include black dots, broken hairs, exclamation mark hairs, tapered hairs, Pohl-Pinkus constrictions, yellow dots, short vellus hairs, upright regrowing hairs and pigtail hairs [4]. ***br /> ***/p> ***p> ***br /> ***/p> ***table class="smwtable-clean"> ***tbody> ***tr> ***th>Trichoscopic feature ***/th> ***th>Reported prevalence in %* (mean value**) ***/th> ***/tr> ***tr> ***td>Yellow dots ***/td> ***td>6 - 100 (62) ***/td> ***/tr> ***tr> ***td>Black dots ***/td> ***td>0 - 84 (53) ***/td> ***/tr> ***tr> ***td>Exclamation mark hairs ***/td> ***td>12 - 71 (39) ***/td> ***/tr> ***tr> ***td>Tapered hairs ***/td> ***td>5 - 81 (51) ***/td> ***/tr> ***tr> ***td>Broken hairs ***/td> ***td>0 - 71 (49) ***/td> ***/tr> ***tr> ***td>Short vellus hairs ***/td> ***td>34 - 100 (61) ***/td> ***/tr> ***tr> ***td>Upright regrowing hairs ***/td> ***td>11 - 96 (23) ***/td> ***/tr> ***tr> ***td>Pigtail (circle) hairs ***/td> ***td>4 - 61 (21) ***/td> ***/tr> ***tr> ***td>Pohl-Pinkus constrictions ***/td> ***td>2 - 10 (4) ***/td> ***/tr> ***/tbody> ***/table> ***p> ***i>Adapted from Waśkiel et al. [5] ***/i> ***br /> ***/p> ***p> ***br /> Active hair loss in %%%mot_cle%%% is characterized by presence of black dots, broken hairs, exclamation mark hairs, tapered hairs and Pohl-Pinkus constrictions [6, 7] [8] [9] [10]. In long-lasting, non-active disease mainly yellow dots and short vellus hairs are observed [10]. ***br /> Good response to the therapy of %%%mot_cle%%% is characterized the reduction followed by the loss of exclamation mark hairs, broken hairs and black dots [11]. Yellow dots are the least responsive [11]. In initial hair regrowth, increased number of short vellus hairs is observed. With the continuation of the therapy they are substituted by fully pigmented terminal hairs so a decreased number of short vellus hairs may be detected [12]. Hair regrowth is characterized by presence of upright regrowing hairs and pigtail hairs [10]. ***br /> ***br /> ***/p> ***div class="center"> ***div class="floatnone"> ***a href="https://dermoscopedia.org/File:AA1.jpg" class="image"> ***img alt="AA1.jpg" src="https://dermoscopedia.org/w/thumb.php?f=AA1.jpg&width=600" decoding="async" width="600" height="338" class="img-fluid" srcset="https://dermoscopedia.org/w/thumb.php?f=AA1.jpg&width=900 1.5x, https://dermoscopedia.org/w/thumb.php?f=AA1.jpg&width=1200 2x" data-file-width="1920" data-file-height="1080" /> ***/a> ***/div> ***/div> ***p>Trichoscopy of %%%mot_cle%%% with presence of exclamation mark hairs. ***/p> ***div class="center"> ***div class="floatnone"> ***a href="https://dermoscopedia.org/File:AA2.jpg" class="image"> ***img alt="AA2.jpg" src="https://dermoscopedia.org/w/thumb.php?f=AA2.jpg&width=600" decoding="async" width="600" height="338" class="img-fluid" srcset="https://dermoscopedia.org/w/thumb.php?f=AA2.jpg&width=900 1.5x, https://dermoscopedia.org/w/thumb.php?f=AA2.jpg&width=1200 2x" data-file-width="1920" data-file-height="1080" /> ***/a> ***/div> ***/div> ***p>Black dots, yellow dots and broken hairs in patient with %%%mot_cle%%%. ***/p> ***div class="center"> ***div class="floatnone"> ***a href="https://dermoscopedia.org/File:AA3.jpg" class="image"> ***img alt="AA3.jpg" src="https://dermoscopedia.org/w/thumb.php?f=AA3.jpg&width=600" decoding="async" width="600" height="451" class="img-fluid" srcset="https://dermoscopedia.org/w/images/4/45/AA3.jpg 1.5x" data-file-width="767" data-file-height="576" /> ***/a> ***/div> ***/div> ***p>Multiple yellow dots in patient with inactive %%%mot_cle%%%. ***/p> ***p> ***br /> Trichoscopic findings of %%%mot_cle%%% include black dots, broken hairs, exclamation mark hairs, tapered hairs, Pohl-Pinkus constrictions, yellow dots, short vellus hairs, upright regrowing hairs and pigtail hairs [4]. ***br /> ***/p> ***p> ***br /> Trichoscopic feature Reported prevalence in %* (mean value**) Yellow dots 6 - 100 (62) Black dots 0 - 84 (53) Exclamation mark hairs 12 - 71 (39) Tapered hairs 5 - 81 (51) Broken hairs 0 - 71 (49) Short vellus hairs 34 - 100 (61) Upright regrowing hairs 11 - 96 (23) Pigtail (circle) hairs 4 - 61 (21) Pohl-Pinkus constrictions 2 - 10 (4) Adapted from Waśkiel et al. [5] ***br /> ***/p> ***p>Active hair loss in %%%mot_cle%%% is characterized by presence of black dots, broken hairs, exclamation mark hairs, tapered hairs and Pohl-Pinkus constrictions [6, 7] [8] [9] [10]. In long-lasting, non-active disease mainly yellow dots and short vellus hairs are observed [10]. Good response to the therapy of %%%mot_cle%%% is characterized the reduction followed by the loss of exclamation mark hairs, broken hairs and black dots [11]. Yellow dots are the least responsive [11]. In initial hair regrowth, increased number of short vellus hairs is observed. With the continuation of the therapy they are substituted by fully pigmented terminal hairs so a decreased number of short vellus hairs may be detected [12]. Hair regrowth is characterized by presence of upright regrowing hairs and pigtail hairs [10]. ***big>Big text ***/big> ***/p> ***p>4. Rudnicka, L., et al., Trichoscopy update 2011. J Dermatol Case Rep, 2011. 5(4): p. 82-8. 5. Waskiel, A., et al., Trichoscopy of %%%mot_cle%%%: An update. J Dermatol, 2018. 6. Guttikonda, A.S., et al., Evaluation of Clinical Significance of Dermoscopy in Alopecia Areata. Indian J Dermatol, 2016. 61(6): p. 628-633. 7. Inui, S., et al., Clinical significance of dermoscopy in %%%mot_cle%%%: analysis of 300 cases. Int J Dermatol, 2008. 47(7): p. 688-93. 8. Kibar, M., et al., Trichoscopic findings in %%%mot_cle%%% and their relation to disease activity, severity and clinical subtype in Turkish patients. Australas J Dermatol, 2015. 56(1): p. e1-6. 9. Inui, S., T. Nakajima, and S. Itami, Coudability hairs: a revisited sign of %%%mot_cle%%% assessed by trichoscopy. Clin Exp Dermatol, 2010. 35(4): p. 361-5. 10. Rudnicka, L., M. Olszewska, and A. Rakowska, Atlas of trichoscopy: dermoscopy in hair and scalp disease. 2012, London: Springer. 11. Ganjoo, S. and D.M. Thappa, Dermoscopic evaluation of therapeutic response to an intralesional corticosteroid in the treatment of %%%mot_cle%%%. Indian J Dermatol Venereol Leprol, 2013. 79(3): p. 408-17. 12. El Taieb, M.A., et al., Platelets rich plasma versus minoxidil 5% in treatment of %%%mot_cle%%%: A trichoscopic evaluation. Dermatol Ther, 2017. 30(1). ***/p> ***!-- NewPP limit report Cached time: 20240908115614 Cache expiry: 0 Dynamic content: true Complications: [] [SMW] In‐text annotation parser time: 0.007 seconds CPU time usage: 0.171 seconds Real time usage: 0.213 seconds Preprocessor visited node count: 384/1000000 Post‐expand include size: 6461/3145728 bytes Template argument size: 430/3145728 bytes Highest expansion depth: 7/50 Expensive parser function count: 0/100 Unstrip recursion depth: 0/20 Unstrip post‐expand size: 1914/5000000 bytes --> ***!-- Transclusion expansion time report (%,ms,calls,template) 100.00% 176.429 1 Template:Page 100.00% 176.429 1 -total 7.60% 13.404 1 Template:LinkToAskQueryForPageOwner 7.30% 12.871 1 Template:MetaElements 1.07% 1.887 1 Template:Clear --> ***/div>

***div class="mw-parser-output"> ***div style="display: none"> ***p> ***a href= "https://dermoscopedia.org/Glossary:Solar_lentigines" title="Glossary:Solar lentigines">Solar lentigines ***/a>, ***a href= "https://dermoscopedia.org/Glossary:Solar_lentigo" title="Glossary:Solar lentigo">Solar lentigo ***/a>, ***a href= "https://dermoscopedia.org/Glossary:Seborrheic_keratoses" title="Glossary:Seborrheic keratoses">Seborrheic keratoses ***/a>, ***a href= "https://dermoscopedia.org/Glossary:Seborrheic_keratosis" title="Glossary:Seborrheic keratosis">Seborrheic keratosis ***/a>, ***a href= "https://dermoscopedia.org/Glossary:Lichen_planus_like_keratosis" title="Glossary:Lichen planus like keratosis">Lichen planus like keratosis ***/a> ***a href= "https://dermoscopedia.org/Cite:Solar_lentigines_/_seborrheic_keratoses_/_lichen_planus-like_keratosis_(full_text)" title="Cite:Solar lentigines / %%%mot_cle%%%s / lichen planus-like keratosis (full text)">Solar lentigines / %%%mot_cle%%%s – cite! ***/a> ***a href= "https://dermoscopedia.org/Message:Solar_lentigines_/_seborrheic_keratoses_/_lichen_planus-like_keratosis_(full_text)" title="Message:Solar lentigines / %%%mot_cle%%%s / lichen planus-like keratosis (full text)">Solar lentigines (message) ***/a> ***a href= "https://dermoscopedia.org/Participate:Solar_lentigines_/_seborrheic_keratoses_/_lichen_planus-like_keratosis_(full_text)" title="Participate:Solar lentigines / %%%mot_cle%%%s / lichen planus-like keratosis (full text)">Solar lentigines / %%%mot_cle%%%s – participate! ***/a> ***/p> ***div style="display: none"> User= ***/div> ***/div> ***div class="thumb tright"> ***div class="thumbinner" style="width:302px;"> ***a href="https://dermoscopedia.org/File:Solar_lentigo_schematic_2.jpg" class="image"> ***img alt="Solar lentigo schematic 2.jpg" src="https://dermoscopedia.org/w/thumb.php?f=Solar_lentigo_schematic_2.jpg&width=300" decoding="async" width="300" height="355" class="thumbimage" srcset="https://dermoscopedia.org/w/thumb.php?f=Solar_lentigo_schematic_2.jpg&width=450 1.5x, https://dermoscopedia.org/w/thumb.php?f=Solar_lentigo_schematic_2.jpg&width=600 2x" data-file-width="1197" data-file-height="1415" /> ***/a> ***div class="thumbcaption"> ***div class="magnify"> ***a href="https://dermoscopedia.org/File:Solar_lentigo_schematic_2.jpg" class="internal" title="Enlarge"> ***/a> ***/div> ***/div> ***/div> ***/div> ***p> ***br /> ***/p> ***div id="toc" class="toc" role="navigation" aria-labelledby="mw-toc-heading"> ***input type="checkbox" role="button" id="toctogglecheckbox" class="toctogglecheckbox" style="display:none" /> ***div class="toctitle" lang="en" dir="ltr"> ***h2 id="mw-toc-heading">Contents ***/h2> ***span class="toctogglespan"> ***label class="toctogglelabel" for="toctogglecheckbox"> ***/label> ***/span> ***/div> ***ul> ***li class="toclevel-1 tocsection-1"> ***a href="#Solar_lentigo"> ***span class="tocnumber">1 ***/span> ***span class="toctext">Solar lentigo ***/span> ***/a> ***ul> ***li class="toclevel-2 tocsection-2"> ***a href="#Moth-eaten_border"> ***span class="tocnumber">1.1 ***/span> ***span class="toctext">Moth-eaten border ***/span> ***/a> ***/li> ***li class="toclevel-2 tocsection-3"> ***a href="#Homogenous_light_brown_pigmentation"> ***span class="tocnumber">1.2 ***/span> ***span class="toctext">Homogenous light brown pigmentation ***/span> ***/a> ***/li> ***li class="toclevel-2 tocsection-4"> ***a href="#Pigment_network"> ***span class="tocnumber">1.3 ***/span> ***span class="toctext">Pigment network ***/span> ***/a> ***/li> ***li class="toclevel-2 tocsection-5"> ***a href="#Fingerprint-like_areas"> ***span class="tocnumber">1.4 ***/span> ***span class="toctext">Fingerprint-like areas ***/span> ***/a> ***/li> ***li class="toclevel-2 tocsection-6"> ***a href="#Pseudonetwork"> ***span class="tocnumber">1.5 ***/span> ***span class="toctext">Pseudonetwork ***/span> ***/a> ***/li> ***li class="toclevel-2 tocsection-7"> ***a href="#Symmetric_brown_follicular_pigmentation"> ***span class="tocnumber">1.6 ***/span> ***span class="toctext">Symmetric brown follicular pigmentation ***/span> ***/a> ***/li> ***li class="toclevel-2 tocsection-8"> ***a href="#Ink-spot_lentigo"> ***span class="tocnumber">1.7 ***/span> ***span class="toctext">Ink-spot lentigo ***/span> ***/a> ***/li> ***/ul> ***/li> ***li class="toclevel-1 tocsection-9"> ***a href="#Seborrheic_keratoses"> ***span class="tocnumber">2 ***/span> ***span class="toctext">Seborrheic keratoses ***/span> ***/a> ***/li> ***li class="toclevel-1 tocsection-10"> ***a href="#Milia-like_cysts:"> ***span class="tocnumber">3 ***/span> ***span class="toctext">Milia-like cysts: ***/span> ***/a> ***/li> ***li class="toclevel-1 tocsection-11"> ***a href="#Comedo-like_openings:"> ***span class="tocnumber">4 ***/span> ***span class="toctext">Comedo-like openings: ***/span> ***/a> ***/li> ***li class="toclevel-1 tocsection-12"> ***a href="#Fissures_and_ridges:"> ***span class="tocnumber">5 ***/span> ***span class="toctext">Fissures and ridges: ***/span> ***/a> ***/li> ***li class="toclevel-1 tocsection-13"> ***a href="#Network-like_structures:"> ***span class="tocnumber">6 ***/span> ***span class="toctext">Network-like structures: ***/span> ***/a> ***/li> ***li class="toclevel-1 tocsection-14"> ***a href="#Cerebriform_pattern:"> ***span class="tocnumber">7 ***/span> ***span class="toctext">Cerebriform pattern: ***/span> ***/a> ***/li> ***li class="toclevel-1 tocsection-15"> ***a href="#Fat-fingers:"> ***span class="tocnumber">8 ***/span> ***span class="toctext">Fat-fingers: ***/span> ***/a> ***/li> ***li class="toclevel-1 tocsection-16"> ***a href="#Sharply_demarcated_borders:"> ***span class="tocnumber">9 ***/span> ***span class="toctext">Sharply demarcated borders: ***/span> ***/a> ***/li> ***li class="toclevel-1 tocsection-17"> ***a href="#Typical_hairpin_blood_vessels_:"> ***span class="tocnumber">10 ***/span> ***span class="toctext">Typical hairpin blood vessels : ***/span> ***/a> ***/li> ***li class="toclevel-1 tocsection-18"> ***a href="#Wobble_test:"> ***span class="tocnumber">11 ***/span> ***span class="toctext">Wobble test: ***/span> ***/a> ***/li> ***li class="toclevel-1 tocsection-19"> ***a href="#Lichen_Planus-like_Keratosis"> ***span class="tocnumber">12 ***/span> ***span class="toctext">Lichen Planus-like Keratosis ***/span> ***/a> ***ul> ***li class="toclevel-2 tocsection-20"> ***a href="#Introduction"> ***span class="tocnumber">12.1 ***/span> ***span class="toctext">Introduction ***/span> ***/a> ***/li> ***li class="toclevel-2 tocsection-21"> ***a href="#Clinical_and_Histologic_Appearance"> ***span class="tocnumber">12.2 ***/span> ***span class="toctext">Clinical and Histologic Appearance ***/span> ***/a> ***ul> ***li class="toclevel-3 tocsection-22"> ***a href="#Early_Stage"> ***span class="tocnumber">12.2.1 ***/span> ***span class="toctext">Early Stage ***/span> ***/a> ***/li> ***li class="toclevel-3 tocsection-23"> ***a href="#Intermediate_Stage"> ***span class="tocnumber">12.2.2 ***/span> ***span class="toctext">Intermediate Stage ***/span> ***/a> ***/li> ***li class="toclevel-3 tocsection-24"> ***a href="#Late_Stage"> ***span class="tocnumber">12.2.3 ***/span> ***span class="toctext">Late Stage ***/span> ***/a> ***/li> ***/ul> ***/li> ***li class="toclevel-2 tocsection-25"> ***a href="#Dermatoscopic_Criteria"> ***span class="tocnumber">12.3 ***/span> ***span class="toctext">Dermatoscopic Criteria ***/span> ***/a> ***ul> ***li class="toclevel-3 tocsection-26"> ***a href="#Early_Stage_LPLK"> ***span class="tocnumber">12.3.1 ***/span> ***span class="toctext">Early Stage LPLK ***/span> ***/a> ***/li> ***li class="toclevel-3 tocsection-27"> ***a href="#Intermediate_Stage_LPL"> ***span class="tocnumber">12.3.2 ***/span> ***span class="toctext">Intermediate Stage LPL ***/span> ***/a> ***/li> ***li class="toclevel-3 tocsection-28"> ***a href="#Late_Stage_LPLK"> ***span class="tocnumber">12.3.3 ***/span> ***span class="toctext">Late Stage LPLK ***/span> ***/a> ***/li> ***/ul> ***/li> ***li class="toclevel-2 tocsection-29"> ***a href="#Differential_diagnosis"> ***span class="tocnumber">12.4 ***/span> ***span class="toctext">Differential diagnosis ***/span> ***/a> ***/li> ***/ul> ***/li> ***/ul> ***/div> ***h2> ***span class="mw-headline" id="Solar_lentigo">Solar lentigo ***/span> ***/h2> ***p>Solar lentigines are sharply circumscribed, uniformly pigmented macules that are located predominantly on the sun-exposed areas of the skin, such as the dorsum of the hands, the shoulders, and the scalp. Lentigines are a result of hyperplasia of keratinocytes and melanocytes, with increased accumulation of melanin in the keratinocytes. They are induced by ultraviolet light exposure. ***/p> ***p>Unlike freckles, solar lentigines persist indefinitely. Nearly 90% of Caucasians over the age of 60 years have these lesions. Due to the increased prevalence of lentigines in the elderly, these lesions are sometimes referred to as “lentigo senilis”. However, younger individuals who tend to burn after ultraviolet exposure can also develop lentigines after acute or prolonged ultraviolet light exposure. Clinically, solar lentigines may be oval, round, or irregular in shape and can vary from a few millimeters to a few centimeters in diameter. Most lesions have a uniform light brown color; however, there are instances when they vary from dark brown to black. One variant of solar lentigo, “ink-spot” lentigo, has a jet-black color. Actinic purpura or other signs of solar damage can frequently be found in the skin surrounding solar lentigines. Solar lentigines are benign lesions that can evolve to a pigmented seborrheic keratosis. Histologically, it is characterized by club-shaped rete ridges with small nub-like extensions. In addition, there is an increased number of melanocytes and increased pigmentation in the basal keratinocytes. Although most solar lentigines are easily recognized on clinical examination, some lesions pose diagnostic challenges because their clinical appearance resembles that of melanoma. Dermoscopy can be helpful in correctly differentiating a solar lentigo from melanoma. The key dermoscopic features of solar lentigines are as follows: ***/p> ***h3> ***span class="mw-headline" id="Moth-eaten_border">Moth-eaten border ***/span> ***/h3> ***p>The presence of a sharply demarcated and irregularly curved border is characteristic of solar lentigines. Often, portions of the border are scalloped, giving a motheaten appearance ***br /> ***/p> ***div class="center"> ***div class="floatnone"> ***a href="https://dermoscopedia.org/File:Moth_eaten.jpg" class="image"> ***img alt="Moth eaten.jpg" src="https://dermoscopedia.org/w/thumb.php?f=Moth_eaten.jpg&width=600" decoding="async" width="600" height="399" class="img-fluid" srcset="https://dermoscopedia.org/w/thumb.php?f=Moth_eaten.jpg&width=900 1.5x, https://dermoscopedia.org/w/thumb.php?f=Moth_eaten.jpg&width=1200 2x" data-file-width="3008" data-file-height="2000" /> ***/a> ***/div> ***/div> ***div style="clear:both;"> ***/div> ***h3> ***span class="mw-headline" id="Homogenous_light_brown_pigmentation">Homogenous light brown pigmentation ***/span> ***/h3> ***p>Many lesions have no structures or networks, only containing light brown and structureless areas; the term “jelly sign” had been proposed to describe the pigment quality of these lesions. The pigment appears as if jelly had been smeared on the skin surface. ***br /> ***/p> ***div class="center"> ***div class="floatnone"> ***a href="https://dermoscopedia.org/File:Homogenous_light_pigmented_SL.jpg" class="image"> ***img alt="Homogenous light pigmented SL.jpg" src="https://dermoscopedia.org/w/thumb.php?f=Homogenous_light_pigmented_SL.jpg&width=600" decoding="async" width="600" height="399" class="img-fluid" srcset="https://dermoscopedia.org/w/thumb.php?f=Homogenous_light_pigmented_SL.jpg&width=900 1.5x, https://dermoscopedia.org/w/thumb.php?f=Homogenous_light_pigmented_SL.jpg&width=1200 2x" data-file-width="4288" data-file-height="2848" /> ***/a> ***/div> ***/div> ***h3> ***span class="mw-headline" id="Pigment_network">Pigment network ***/span> ***/h3> ***p>There may be an area of faint, reticulation. This correlates with the presence of melanocytes and melanin-filled keratinocytes in the rete ridges. ***/p> ***div class="center"> ***div class="thumb tnone"> ***div class="thumbinner" style="width:602px;"> ***a href="https://dermoscopedia.org/File:SL_1.jpg" class="image"> ***img alt="" src="https://dermoscopedia.org/w/thumb.php?f=SL_1.jpg&width=600" decoding="async" width="600" height="450" class="thumbimage" srcset="https://dermoscopedia.org/w/thumb.php?f=SL_1.jpg&width=900 1.5x, https://dermoscopedia.org/w/images/1/18/SL_1.jpg 2x" data-file-width="1024" data-file-height="768" /> ***/a> ***div class="thumbcaption"> ***div class="magnify"> ***a href="https://dermoscopedia.org/File:SL_1.jpg" class="internal" title="Enlarge"> ***/a> ***/div>A solar lentigo with pigment network and some finger print-like areas (see below) ***/div> ***/div> ***/div> ***/div> ***div style="clear:both;"> ***/div> ***h3> ***span class="mw-headline" id="Fingerprint-like_areas">Fingerprint-like areas ***/span> ***/h3> ***p>They are areas consisting of fine parallel running lines of light brown to dark brown colors. They resemble the dermatoglyphics of a human fingerprint. ***/p> ***div class="center"> ***div class="floatnone"> ***a href="https://dermoscopedia.org/File:Untitled_Artwork_24.jpg" class="image"> ***img alt="Untitled Artwork 24.jpg" src="https://dermoscopedia.org/w/thumb.php?f=Untitled_Artwork_24.jpg&width=600" decoding="async" width="600" height="450" class="img-fluid" srcset="https://dermoscopedia.org/w/thumb.php?f=Untitled_Artwork_24.jpg&width=900 1.5x, https://dermoscopedia.org/w/thumb.php?f=Untitled_Artwork_24.jpg&width=1200 2x" data-file-width="2732" data-file-height="2048" /> ***/a> ***/div> ***/div> ***h3> ***span class="mw-headline" id="Pseudonetwork">Pseudonetwork ***/span> ***/h3> ***p>Lentigines located on the scalp and face share features of pigmented melanocytic lesions in this special location revealing a pseudonetwork pattern. This is created when a diffusely pigmented area is interrupted by nonpigmented adnexal openings . ***/p> ***h3> ***span class="mw-headline" id="Symmetric_brown_follicular_pigmentation">Symmetric brown follicular pigmentation ***/span> ***/h3> ***p>In a solar lentigo the pigment around hair follicles is distributed in a symmetric fashion creating small brown circles. The pigment is usually light brown in color and similar to the color of the rest of the lesion. While the pigment is usually distributed symmetrically around the follicle, some follicles may appear asymmetrically pigmented. These asymmetrically pigmented follicles appear as brown crescent shaped structures. However, these asymmetric follicles will also have a brown color like the rest of the lesion. If the color of the pigment around the follicle, whether symmetric or asymmetric, is of a grayish hue or differs from the rest of the lesion then melanoma needs to enter the differential diagnosis. ***br /> ***/p> ***h3> ***span class="mw-headline" id="Ink-spot_lentigo">Ink-spot lentigo ***/span> ***/h3> ***p>Ink-spot lentigines have their own distinct dermoscopic pattern.These lesions have a very prominent blackpigmented network, which has an almost three-dimensional quality under dermoscopy. The network lines can be either thin or thick in width, and the network ends abruptly at the edge of the lesion ***br /> ***br /> ***/p> ***p> ***br /> ***/p> ***div class="thumb tright"> ***div class="thumbinner" style="width:302px;"> ***a href="https://dermoscopedia.org/File:Seb_k_schematic_2.jpg" class="image"> ***img alt="Seb k schematic 2.jpg" src="https://dermoscopedia.org/w/thumb.php?f=Seb_k_schematic_2.jpg&width=300" decoding="async" width="300" height="313" class="thumbimage" srcset="https://dermoscopedia.org/w/thumb.php?f=Seb_k_schematic_2.jpg&width=450 1.5x, https://dermoscopedia.org/w/thumb.php?f=Seb_k_schematic_2.jpg&width=600 2x" data-file-width="1668" data-file-height="1741" /> ***/a> ***div class="thumbcaption"> ***div class="magnify"> ***a href="https://dermoscopedia.org/File:Seb_k_schematic_2.jpg" class="internal" title="Enlarge"> ***/a> ***/div> ***/div> ***/div> ***/div> ***h2> ***span class="mw-headline" id="Seborrheic_keratoses">Seborrheic keratoses ***/span> ***/h2> ***p> ***b>Seborrheic keratoses ***/b> are benign epithelial lesions that can appear on any part of the body except for the mucous membranes, palms, and soles. The lesions are quite prevalent in people older than 30 years. The etiology of %%%mot_cle%%%s remains unclear. Ultraviolet light exposure may be responsible for the development of some %%%mot_cle%%%s because they appear to evolve from solar lentigines; however, many develop in areas of the skin naturally protected from ultraviolet light exposure, such as the inframammary (intertriginous) areas. Clinically, early %%%mot_cle%%%s are light- to dark brown oval macules with sharply demarcated borders (solar lentigo). As the lesions progress, they transform into plaques with a waxy or stuck-on appearance ***sup id="cite_ref-1" class="reference"> ***a href="#cite_note-1">[1] ***/a> ***/sup>. The surfaces of these lesions have a warty and keratotic appearance. Often, the lesions have follicular plugs scattered over their surfaces. The size of the lesions varies from a few millimeters to a few centimeters. Histologically, there are several distinct forms of %%%mot_cle%%%s. In general, the lesions are characterized by papillomatous epidermal hyperplasia of uniform and monotonous keratinocytes and the presence of pseudocysts. The diagnosis of most %%%mot_cle%%%s is straightforward. However, some %%%mot_cle%%%s, especially the deeply pigmented variant, can simulate malignant melanomas. Thin, early lesions have moth-eaten borders and fingerprint-like structures as described for solar lentigines. Thicker pigmented %%%mot_cle%%%s have the typical dermoscopy features as follows ***sup id="cite_ref-PM12472342_2-0" class="reference"> ***a href="#cite_note-PM12472342-2">[2] ***/a> ***/sup>: ***br /> ***/p> ***div class="center"> ***div class="floatnone"> ***a href="https://dermoscopedia.org/File:Seb_k_schematic.jpg" class="image"> ***img alt="Seb k schematic.jpg" src="https://dermoscopedia.org/w/thumb.php?f=Seb_k_schematic.jpg&width=600" decoding="async" width="600" height="450" class="img-fluid" srcset="https://dermoscopedia.org/w/thumb.php?f=Seb_k_schematic.jpg&width=900 1.5x, https://dermoscopedia.org/w/thumb.php?f=Seb_k_schematic.jpg&width=1200 2x" data-file-width="2732" data-file-height="2048" /> ***/a> ***/div> ***/div> ***div style="clear:both;"> ***/div> ***p> ***br /> ***/p> ***h2> ***span class="mw-headline" id="Milia-like_cysts:">Milia-like cysts: ***/span> ***/h2> ***p>They are white-to-yellow, round structures that appear very bright when contrasted with their dark brown or black surroundings. The presence of multiple milia-like cysts in pigmented %%%mot_cle%%%s conjures up an image of “stars in the sky.” Milia-like cysts can also be seen in non-pigmented seborrheic keratosis and other lesions such as basal cell carcinoma and melanocytic lesions including congenital nevi and melanoma. However, if the lesion is non-melanocytic and is not a basal cell carcinoma then the presence of milia-like cyst is diagnostic of %%%mot_cle%%%s specially if more then three are seen. It is interesting to note that the quality of milia-like cysts appear somewhat different in seborrheic keratosis and melanocytic lesions. In melanoma and congenital nevi the cysts appear “starry”, which is defined as small, bright and sharp. In seborrheic keratosis they appear “cloudy”, defined as larger and hazier in appearance. Histologically, the cysts correspond to intraepidermal, keratin-filled cysts. It is important to be aware that milia-like cysts are more conspicuous with non-polarized dermoscopy and are often difficult to visualize with polarized dermoscopy. ***br /> ***/p> ***div class="center"> ***div class="floatnone"> ***a href="https://dermoscopedia.org/File:Milia_like_cysts.JPG" class="image"> ***img alt="Milia like cysts.JPG" src="https://dermoscopedia.org/w/images/1/1a/Milia_like_cysts.JPG" decoding="async" width="600" height="733" class="img-fluid" data-file-width="526" data-file-height="643" /> ***/a> ***/div> ***/div> ***div style="clear:both;"> ***/div> ***p> ***br /> ***/p> ***h2> ***span class="mw-headline" id="Comedo-like_openings:">Comedo-like openings: ***/span> ***/h2> ***p>They are round to ovoid craters that have black or brown comedo like plugs. Histologically, they correlate with keratin-filled invaginations of the skin surface. ***br /> ***br /> ***/p> ***div class="center"> ***div class="floatnone"> ***a href="https://dermoscopedia.org/File:Comedo_like_opening.JPG" class="image"> ***img alt="Comedo like opening.JPG" src="https://dermoscopedia.org/w/thumb.php?f=Comedo_like_opening.JPG&width=600" decoding="async" width="600" height="598" class="img-fluid" srcset="https://dermoscopedia.org/w/images/6/63/Comedo_like_opening.JPG 1.5x" data-file-width="717" data-file-height="715" /> ***/a> ***/div> ***/div> ***div style="clear:both;"> ***/div> ***p> ***br /> ***/p> ***h2> ***span class="mw-headline" id="Fissures_and_ridges:">Fissures and ridges: ***/span> ***/h2> ***p>Fissures (sulci) are comedo-like openings, which are not round but rather linear and appear as dark brown to black linear to curvilinear structures within the lesion. The presence of numerous fissures and ridges can result in the formation of network-like structures or result in a cerebriform pattern. Histologically, they represent deep invaginations of the epidermis, filled with keratin. ***br /> ***br /> ***/p> ***div class="center"> ***div class="floatnone"> ***a href="https://dermoscopedia.org/File:Seb_Ker_sulci.jpg" class="image"> ***img alt="Seb Ker sulci.jpg" src="https://dermoscopedia.org/w/thumb.php?f=Seb_Ker_sulci.jpg&width=600" decoding="async" width="600" height="448" class="img-fluid" srcset="https://dermoscopedia.org/w/images/d/d9/Seb_Ker_sulci.jpg 1.5x" data-file-width="740" data-file-height="553" /> ***/a> ***/div> ***/div> ***div style="clear:both;"> ***/div> ***p> ***br /> ***/p> ***h2> ***span class="mw-headline" id="Network-like_structures:">Network-like structures: ***/span> ***/h2> ***p>Interlacing fissures and ridges can create an appearance of network-like structures. The quality of the grid of network-like structures in a seborrheic keratosis differs from the network grid seen in melanocytic nevi by being significantly larger. However, at times the network-like structure in a seborrheic keratosis can look very similar to that of a nevus. Clinical examination of the lesion via side lighting can make the ridges more evident, thereby making it easier to differentiate network-like ridges in seborrheic keratosis and pigment network in melanocytic lesions. ***/p> ***h2> ***span class="mw-headline" id="Cerebriform_pattern:">Cerebriform pattern: ***/span> ***/h2> ***p>Multiple fissures (sulci) and ridges (gyri) may produce a cerebriform pattern, where the structures resemble sulci and gyri of the brain (brain-like appearance). These features are generally associated with an acanthotic seborrheic keratosis. ***/p> ***h2> ***span class="mw-headline" id="Fat-fingers:">Fat-fingers: ***/span> ***/h2> ***p>Fat fingers are linear and wide dermoscopic structures corresponding to ridges. They often appear as short sausage-shaped structures. Their colors vary from tan/brown, blue to hypopigmented. They are named fat-fingers because their shapes can resemble a straight finger (linear), bent finger (curvi-linear), or finger tip (oval–circular). ***br /> ***/p> ***div class="center"> ***div class="floatnone"> ***a href="https://dermoscopedia.org/File:Seb_Ker_Fat_Fingers.jpg" class="image"> ***img alt="Seb Ker Fat Fingers.jpg" src="https://dermoscopedia.org/w/thumb.php?f=Seb_Ker_Fat_Fingers.jpg&width=600" decoding="async" width="600" height="803" class="img-fluid" srcset="https://dermoscopedia.org/w/thumb.php?f=Seb_Ker_Fat_Fingers.jpg&width=900 1.5x, https://dermoscopedia.org/w/thumb.php?f=Seb_Ker_Fat_Fingers.jpg&width=1200 2x" data-file-width="1936" data-file-height="2592" /> ***/a> ***/div> ***/div> ***div style="clear:both;"> ***/div> ***h2> ***span class="mw-headline" id="Sharply_demarcated_borders:">Sharply demarcated borders: ***/span> ***/h2> ***p>As known from clinical examination, seborrheic keratosis often have sharply demarcated borders. ***/p> ***h2> ***span class="mw-headline" id="Typical_hairpin_blood_vessels_:">Typical hairpin blood vessels : ***/span> ***/h2> ***p>Some %%%mot_cle%%%s are associated with hairpin vessels. These hairpin vessels can appear as perfect “U”-shaped vessels of as “U”-shaped vessels that are twisted upon themselves. Typical hairpin blood vessels have a whitish halo around the blood vessel corresponding to the surrounding keratin. It is important to note that some melanomas can have hairpin vessels, but these vessels generally do not have the surrounding white halo but rather have a pink halo. Similar hairpin vessels on a pink background can be seen in irritated seborrheic keratosis. ***/p> ***h2> ***span class="mw-headline" id="Wobble_test:">Wobble test: ***/span> ***/h2> ***p>This is a dynamic test that can only be performed with a contact dermoscopy device. The test is performed as follows: once the contact plate of the dermoscope is firmly pressed down (pressure in vertical direction) against the lesion, it is then moved slightly back and forth in the horizontal plane (parallel to the skin surface). Seborrheic keratosis will appear to stick to the glass plate and move en bloc with the movement of the dermoscopic face plate. In other words, they will slide back and forth. In contrast, nevi will not move en bloc but, rather roll back and forth. In other words, intradermal nevi will wobble. Knowledge of the above-described dermoscopic features and patterns seen in seborrheic keratosis will often prove valuable in differentiating %%%mot_cle%%%s from other lesions, including melanoma. However, irritated or traumatized %%%mot_cle%%%s can mimic melanoma or squamous cell carcinoma. In these cases the history of trauma or the presence of typical criteria for %%%mot_cle%%%s in another part of the lesion might be comforting. However, it is important to remember that skin cancer can develop within a seborrheic keratosis, and thus a biopsy is justified for atypical appearing seborrheic keratosis. ***br /> ***/p> ***p> ***br /> ***br /> ***/p> ***h2> ***span class="mw-headline" id="Lichen_Planus-like_Keratosis">Lichen Planus-like Keratosis ***/span> ***/h2> ***h3> ***span class="mw-headline" id="Introduction">Introduction ***/span> ***/h3> ***p>Lichen planus-like keratosis, also known as LPLK and lichenoid keratosis, is one of the common benign neoplasms of the skin. It is believed to be either a seborrheic keratosis or a solar lentigo that is undergoing regression. Supporting evidence has been published beginning with Mehregan’s findings of the presence of lentiginous epidermal hyperplasia in lesions interpreted as LPLK ***sup id="cite_ref-PM127813_3-0" class="reference"> ***a href="#cite_note-PM127813-3">[3] ***/a> ***/sup>. Further supporting evidence can be found by Laur, et al who in 1981 published a detailed clinical-histopathologic correlation in the JAAD ***sup id="cite_ref-PM7217401_4-0" class="reference"> ***a href="#cite_note-PM7217401-4">[4] ***/a> ***/sup>. In addition, Goldenhersh et al ***sup id="cite_ref-PM3771875_5-0" class="reference"> ***a href="#cite_note-PM3771875-5">[5] ***/a> ***/sup>, described performing biopsies of lentigines on two instances. The first being a biopsy of a solar lentigo and 5 years later, after the lesion had demonstrated a clinical change into a solitary lichen planus‐like keratosis. ***/p> ***h3> ***span class="mw-headline" id="Clinical_and_Histologic_Appearance">Clinical and Histologic Appearance ***/span> ***/h3> ***p>Lichen planus-like keratosis is a great masquerader with a differential diagnosis including basal cell carcinoma, squamous cell carcinoma and melanoma. The wide differential diagnosis is due to the extreme variability in characteristic appearance with many pigmentation and morphologic possibilities. The clinical appearance depends on its stage of evolution. ***/p> ***p>The lesion can appear as a macule or papule that is pink, pinkish brown, pinkish orange, rust colored, purplish brown, dusky violaceous or blue-gray to black. Some lesions are characterized by a velvety appearance, some have a fine scale, while others have accentuated skin markings. Lesions can be solitary or in some cases multiple. ***/p> ***p> ***br /> ***/p> ***h4> ***span class="mw-headline" id="Early_Stage">Early Stage ***/span> ***/h4> ***p>The histologic features of early stage of LPLK include hypergranulosis, epidermal hyperplasia, a few necrotic keratinocytes and a superficial, bandlike lichenoid infiltrate. Clinically these lesions appear as pink macules or papules and may be difficult to distinguish from basal cell carcinoma or squamous cell carcinoma. ***/p> ***p> ***br /> ***/p> ***h4> ***span class="mw-headline" id="Intermediate_Stage">Intermediate Stage ***/span> ***/h4> ***p>Histologically intermediate stage LPLK is characterized by melanophages, inflammatory cells and fibrosis, with features consistent with either a lentigo or a seborrheic keratosis. In some cases, clinically, the lesion may be difficult to distinguish from melanoma (melanoma on sun-damaged skin, lentiginous melanoma, lentigo maligna melanoma). ***/p> ***p> ***br /> ***/p> ***h4> ***span class="mw-headline" id="Late_Stage">Late Stage ***/span> ***/h4> ***p>Late stage LPLK is characterized histologically by papillary fibrosis, telangiectasias, and melanophages. The lesions have a more blue-gray to black clinical appearance and may be difficult to distinguish from melanoma. ***/p> ***h3> ***span class="mw-headline" id="Dermatoscopic_Criteria">Dermatoscopic Criteria ***/span> ***/h3> ***p>Dermoscopy allows the detailed visualization of the structures found within the epidermis, dermoepidermal junction and papillary dermis. This information creates a bridge between the clinical and histologic correlates, thus narrowing the differential and allowing for a more accurate assessment of the lesion. ***/p> ***p> ***br /> ***/p> ***h4> ***span class="mw-headline" id="Early_Stage_LPLK">Early Stage LPLK ***/span> ***/h4> ***p>Lichen planus-like keratosis in its early stage is characterized by polymorphous vessels: dotted vessels and short thin vessels that are either linear, slightly curved or serpentine in appearance. The lesions may appear structureless, pink-white with an orange or yellow hue, colors that are not bright nor saturated, borders that are scalloped and a scale. Shiny white structures (SWS, or crystalline structures) are commonly seen with LPLK, that appear as white strands or blotches. Rosettes can also be seen with LPLKs that coincide with actinically damaged skin. ***/p> ***p>Here are two examples of early stage LPLKs: ***/p> ***div class="center"> ***div class="floatnone"> ***a href="https://dermoscopedia.org/File:Early_stage_lplk_2.jpg" class="image"> ***img alt="Early stage lplk 2.jpg" src="https://dermoscopedia.org/w/thumb.php?f=Early_stage_lplk_2.jpg&width=600" decoding="async" width="600" height="400" class="img-fluid" srcset="https://dermoscopedia.org/w/thumb.php?f=Early_stage_lplk_2.jpg&width=900 1.5x, https://dermoscopedia.org/w/thumb.php?f=Early_stage_lplk_2.jpg&width=1200 2x" data-file-width="6000" data-file-height="4000" /> ***/a> ***/div> ***/div> ***div style="clear:both;"> ***/div> ***div class="center"> ***div class="floatnone"> ***a href="https://dermoscopedia.org/File:Early_stage_LPLK.jpg" class="image"> ***img alt="Early stage LPLK.jpg" src="https://dermoscopedia.org/w/thumb.php?f=Early_stage_LPLK.jpg&width=600" decoding="async" width="600" height="803" class="img-fluid" srcset="https://dermoscopedia.org/w/thumb.php?f=Early_stage_LPLK.jpg&width=900 1.5x, https://dermoscopedia.org/w/thumb.php?f=Early_stage_LPLK.jpg&width=1200 2x" data-file-width="1936" data-file-height="2592" /> ***/a> ***/div> ***/div> ***div style="clear:both;"> ***/div> ***h4> ***span class="mw-headline" id="Intermediate_Stage_LPL">Intermediate Stage LPL ***/span> ***/h4> ***p>Lichen planus-like keratosis in the intermediate phase is characterized by two patterns. The first pattern depicts the dermoscopic features of a solar lentigo (fine lines parallel; straight, slightly curved, long or short, with sharply demarcated and scalloped borders) with the addition of regression structures: focal gray dots/granules. ***br /> ***br /> ***/p> ***div class="center"> ***div class="floatnone"> ***a href="https://dermoscopedia.org/File:INTERMEDIATE_lplk_sl.jpg" class="image"> ***img alt="INTERMEDIATE lplk sl.jpg" src="https://dermoscopedia.org/w/thumb.php?f=INTERMEDIATE_lplk_sl.jpg&width=600" decoding="async" width="600" height="803" class="img-fluid" srcset="https://dermoscopedia.org/w/thumb.php?f=INTERMEDIATE_lplk_sl.jpg&width=900 1.5x, https://dermoscopedia.org/w/thumb.php?f=INTERMEDIATE_lplk_sl.jpg&width=1200 2x" data-file-width="1936" data-file-height="2592" /> ***/a> ***/div> ***/div> ***div style="clear:both;"> ***/div> ***p>The second pattern portrays the features of a seborrheic keratosis (borders sharply demarcated, milia-like cysts, comedo-like openings, fissures, ridges, looped vessels and fine vessels surrounded by a halo) with the addition of regression structures: focal gray dots/granules. ***br /> ***br /> ***/p> ***div class="center"> ***div class="floatnone"> ***a href="https://dermoscopedia.org/File:Intermediate_LPLK_SK.jpg" class="image"> ***img alt="Intermediate LPLK SK.jpg" src="https://dermoscopedia.org/w/thumb.php?f=Intermediate_LPLK_SK.jpg&width=600" decoding="async" width="600" height="803" class="img-fluid" srcset="https://dermoscopedia.org/w/thumb.php?f=Intermediate_LPLK_SK.jpg&width=900 1.5x, https://dermoscopedia.org/w/thumb.php?f=Intermediate_LPLK_SK.jpg&width=1200 2x" data-file-width="1936" data-file-height="2592" /> ***/a> ***/div> ***/div> ***div style="clear:both;"> ***/div> ***h4> ***span class="mw-headline" id="Late_Stage_LPLK">Late Stage LPLK ***/span> ***/h4> ***p>Lichen planus-like keratosis in the late phase is characterized by scattered clumps of pigment with diffuse gray dots/granules or gray dots/granules that form what is known as a diffuse granular pattern, and borders that are often scalloped or have a moth-eaten appearance. ***/p> ***div class="center"> ***div class="floatnone"> ***a href="https://dermoscopedia.org/File:Late_stage_LPLK3.jpg" class="image"> ***img alt="Late stage LPLK3.jpg" src="https://dermoscopedia.org/w/thumb.php?f=Late_stage_LPLK3.jpg&width=600" decoding="async" width="600" height="443" class="img-fluid" srcset="https://dermoscopedia.org/w/images/4/4e/Late_stage_LPLK3.jpg 1.5x" data-file-width="850" data-file-height="627" /> ***/a> ***/div> ***/div> ***div style="clear:both;"> ***/div> ***h3> ***span class="mw-headline" id="Differential_diagnosis">Differential diagnosis ***/span> ***/h3> ***p>In a recent study for the US ***sup id="cite_ref-PM_30450536_6-0" class="reference"> ***a href="#cite_note-PM_30450536-6">[6] ***/a> ***/sup> LPLKs were compared with non-LPLK cutaneous lesions. LPLKs had the clinical differential diagnosis of basal cell carcinoma, squamous cell carcinoma, neavus, melanoma, seborrehic keratosis, lentigo, and actinic keratosis. Dermoscopic features that were found to distinguish LPLKs from other lesions include: Overall organized dermoscopic structures, scale, orange color, coarse +/- fine granules and peppering as the only feature present. LPLKs were less likely to have moth-eaten borders and irregular dots compared to the other lesions. ***/p> ***p> ***br /> ***br /> ***/p> ***div style="font-size: 1.8rem; border-bottom: 1px solid #a2a9b1; width: 100%">References: ***/div> ***div style="clear:both;"> ***/div> ***div class="mw-references-wrap"> ***ol class="references"> ***li id="cite_note-1"> ***span class="mw-cite-backlink"> ***a href="#cite_ref-1">↑ ***/a> ***/span> ***span class="reference-text">An Atlas of Dermoscopy, Second Edition. Marghoob A. et al. CRC Press; 2012. ***/span> ***/li> ***li id="cite_note-PM12472342-2"> ***span class="mw-cite-backlink"> ***a href="#cite_ref-PM12472342_2-0">↑ ***/a> ***/span> ***span class="reference-text">Braun ***i>et al. ***/i>: Dermoscopy of pigmented seborrheic keratosis: a morphological study. ***i>Arch Dermatol ***/i> 2002;138:1556-60. PMID:  ***a class="external text" href="https://www.ncbi.nlm.nih.gov/pubmed/12472342">12472342 ***/a>. ***/span> ***/li> ***li id="cite_note-PM127813-3"> ***span class="mw-cite-backlink"> ***a href="#cite_ref-PM127813_3-0">↑ ***/a> ***/span> ***span class="reference-text">Mehregan: Lentigo senilis and its evolutions. ***i>J. Invest. Dermatol. ***/i> 1975;65:429-33. PMID:  ***a class="external text" href="https://www.ncbi.nlm.nih.gov/pubmed/127813">127813 ***/a>. ***/span> ***/li> ***li id="cite_note-PM7217401-4"> ***span class="mw-cite-backlink"> ***a href="#cite_ref-PM7217401_4-0">↑ ***/a> ***/span> ***span class="reference-text">Laur ***i>et al. ***/i>: Lichen planus-like keratosis. A clinicohistopathologic correlation. ***i>J. Am. Acad. Dermatol. ***/i> 1981;4:329-36. PMID:  ***a class="external text" href="https://www.ncbi.nlm.nih.gov/pubmed/7217401">7217401 ***/a>. ***/span> ***/li> ***li id="cite_note-PM3771875-5"> ***span class="mw-cite-backlink"> ***a href="#cite_ref-PM3771875_5-0">↑ ***/a> ***/span> ***span class="reference-text">Goldenhersh ***i>et al. ***/i>: Documented evolution of a solar lentigo into a solitary lichen planus-like keratosis. ***i>J. Cutan. Pathol. ***/i> 1986;13:308-11. PMID:  ***a class="external text" href="https://www.ncbi.nlm.nih.gov/pubmed/3771875">3771875 ***/a>. ***/span> ***/li> ***li id="cite_note-PM_30450536-6"> ***span class="mw-cite-backlink"> ***a href="#cite_ref-PM_30450536_6-0">↑ ***/a> ***/span> ***span class="reference-text">Liopyris ***i>et al. ***/i>: Clinical and dermoscopic features associated with lichen planus-like keratoses that undergo skin biopsy: A single-center, observational study. ***i>Australas. J. Dermatol. ***/i> 2018;. PMID:  ***a class="external text" href="https://www.ncbi.nlm.nih.gov/pubmed/30450536">30450536 ***/a>. ***a class="external text" href="https://dx.doi.org/10.1111/ajd.12955">DOI ***/a>. ***/span> ***/li> ***/ol> ***/div> ***!-- NewPP limit report Cached time: 20240908115616 Cache expiry: 0 Dynamic content: true Complications: [] [SMW] In‐text annotation parser time: 0 seconds CPU time usage: 0.239 seconds Real time usage: 0.279 seconds Preprocessor visited node count: 905/1000000 Post‐expand include size: 12396/3145728 bytes Template argument size: 1536/3145728 bytes Highest expansion depth: 7/50 Expensive parser function count: 0/100 Unstrip recursion depth: 0/20 Unstrip post‐expand size: 3250/5000000 bytes --> ***!-- Transclusion expansion time report (%,ms,calls,template) 100.00% 255.468 1 -total 73.07% 186.679 1 Template:Page 7.74% 19.763 5 Template:PubMed 4.45% 11.375 1 Template:MetaElements 2.25% 5.753 1 Template:LinkToAskQueryForPageOwner 1.29% 3.305 5 Template:Pubmed 0.93% 2.385 14 Template:Clear 0.76% 1.943 1 Template:H2 --> ***/div>

***div class="mw-parser-output"> ***div style="display: none"> ***p> ***a href= "https://dermoscopedia.org/Glossary:Bowen%27s_disease" title="Glossary:Bowen's disease">Bowen's disease ***/a>, ***a href= "https://dermoscopedia.org/Glossary:Actinic_keratosis" title="Glossary:Actinic keratosis">Actinic keratosis ***/a>, ***a href= "https://dermoscopedia.org/Glossary:Keratoacanthoma" title="Glossary:Keratoacanthoma">Keratoacanthoma ***/a>, ***a href= "https://dermoscopedia.org/Glossary:Squamous_cell_carcinoma" title="Glossary:Squamous cell carcinoma">Squamous cell carcinoma ***/a> ***a href= "https://dermoscopedia.org/Cite:Actinic_keratosis_/_Bowen%27s_disease_/_keratoacanthoma_/_squamous_cell_carcinoma" title="Cite:Actinic keratosis / Bowen's disease / keratoacanthoma / squamous cell carcinoma">Actinic keratosis / Bowen's disease / keratoacanthoma – cite! ***/a> ***a href= "https://dermoscopedia.org/Message:Actinic_keratosis_/_Bowen%27s_disease_/_keratoacanthoma_/_squamous_cell_carcinoma" title="Message:Actinic keratosis / Bowen's disease / keratoacanthoma / squamous cell carcinoma">Actinic keratosis (message) ***/a> ***a href= "https://dermoscopedia.org/Participate:Actinic_keratosis_/_Bowen%27s_disease_/_keratoacanthoma_/_squamous_cell_carcinoma" title="Participate:Actinic keratosis / Bowen's disease / keratoacanthoma / squamous cell carcinoma">Actinic keratosis / Bowen's disease / keratoacanthoma – participate! ***/a> ***/p> ***div style="display: none"> User= ***/div> ***/div> ***p> ***b>Actinic (solar) keratosis (AK), Bowen’s disease (BD), keratoacanthoma (KA), and squamous cell carcinoma (SCC) ***/b> comprise the spectrum of premalignant and malignant keratinizing tumors. In contrast to the well-defined dermoscopic criteria of pigmented tumors, the dermoscopic features of these, mostly non-pigmented keratinizing tumors, are less well established. Most of the described dermoscopic patterns are based on case series. The dermoscopic diagnosis of these tumors is mainly based on the assessment of vascular patterns. The architectural arrangement and distribution of the vessels within the lesion and the correlation with the clinical assessment (e.g. texture, firmness) may provide improved specificity. Other associated, but nonspecific features are erythema, scale, erosion or keratin. Since their diagnosis is mostly based on the ability to visualize blood vessels under dermoscopy, the use of polarized light dermoscopy instruments is preferred as it seems to provide the best method to visualize vascular structures. In addition, using a viscous immersion medium, such as ultrasound gel, when applying contact dermoscopy, will allow for better visualization of the vascular structures as it eliminates the effect of pressure-induced compression of blood vessels. ***br /> ***/p> ***div style="max-width:400px"> ***p> ***div class="videoWrapper"> ***iframe width="400" height="300" src="https://www.youtube.com/embed/ExE-zDCB-r0" frameborder="0" allowfullscreen> ***/iframe> ***/div> ***br /> ***/p> ***/div> ***div style="max-width:400px"> ***p> ***div class="videoWrapper"> ***iframe width="400" height="300" src="https://www.youtube.com/embed/_4MHr_kMTNw" frameborder="0" allowfullscreen> ***/iframe> ***/div> ***br /> ***/p> ***/div> ***div style="max-width:400px"> ***p> ***div class="videoWrapper"> ***iframe width="400" height="300" src="https://www.youtube.com/embed/4Ji4eNuz8Zg" frameborder="0" allowfullscreen> ***/iframe> ***/div> ***br /> ***/p> ***/div> ***div style="max-width:400px"> ***p> ***div class="videoWrapper"> ***iframe width="400" height="300" src="https://www.youtube.com/embed/29fDo1n8fPY" frameborder="0" allowfullscreen> ***/iframe> ***/div> ***br /> ***/p> ***/div> ***div style="max-width:400px"> ***p> ***div class="videoWrapper"> ***iframe width="400" height="300" src="https://www.youtube.com/embed/1O4E-aTIIiY" frameborder="0" allowfullscreen> ***/iframe> ***/div> ***br /> ***/p> ***/div> ***div style="max-width:400px"> ***p> ***div class="videoWrapper"> ***iframe width="400" height="300" src="https://www.youtube.com/embed/rqrEec-LNuI" frameborder="0" allowfullscreen> ***/iframe> ***/div> ***br /> ***/p> ***/div> ***div style="max-width:400px"> ***p> ***div class="videoWrapper"> ***iframe width="400" height="300" src="https://www.youtube.com/embed/1O4E-aTIIiY" frameborder="0" allowfullscreen> ***/iframe> ***/div> ***br /> ***/p> ***/div> ***div style="max-width:400px"> ***p> ***div class="videoWrapper"> ***iframe width="400" height="300" src="https://www.youtube.com/embed/43_Zz30qIUA" frameborder="0" allowfullscreen> ***/iframe> ***/div> ***br /> ***/p> ***/div> ***p> ***br /> ***br /> ***/p> ***div style="font-size: 1.8rem; border-bottom: 1px solid #a2a9b1; width: 100%">References ***/div> ***div style="clear:both;"> ***/div> ***ol> ***li>An Atlas of Dermoscopy, Second Edition. Marghoob A. et al. CRC Press; 2012. ***/li> ***li>Argenziano, G., Zalaudek, I., Corona, R., et al., 2004, Vascular structures in skin tumors: a dermoscopy study. Arch Dermatol, 140, 1485–9. ***/li> ***li>Bauer, J., Leinweber, B., Metzler, G., et al., 2006, Correlation with digital dermo- scopic images can help dermatopathologists to diagnose equivocal skin tumours. Br J Dermatol, 155, 546–51. ***/li> ***li>Bugatti, L., Filosa, G. & De Angelis, R., 2004, Dermoscopic observation of Bowen’s disease. J Eur Acad Dermatol Venereol, 18, 572–4. ***/li> ***li>Bugatti, L., Filosa, G. & De Angelis, R., 2007, The specific dermoscopical criteria of Bowen’s disease. J Eur Acad Dermatol Venereol, 21, 700–1. ***/li> ***li>Cuellar, F., Vilalta, A., Puig, S., et al., 2009, New dermoscopic pattern in %%%mot_cle%%% and related conditions. Arch Dermatol, 145, 732. ***/li> ***li>Felder S., Rabinovitz H., Oliviero M., Kopf A., 2006, Dermoscopic differentiation of a superficial basal cell carcinoma and squamous cell carcinoma in situ. Dermatol Surg, 32, 423–5. ***/li> ***li>Kittler, H., Riedl, E., Rosendahl, C. & Cameron, A., 2008, Dermatoscopy of unpig- mented lesions of the skin: a new classification of vessel morphology based on pattern analysis. Dermatopathol Pract Conc, 14, 4. ***/li> ***li>Kreusch, J. & Koch, F., 1996, Auflichtmikroskopische Charakterisierung von Gefass- mustern in Hauttumoren. Hautarzt, 47, 264–72. ***/li> ***li>Kreusch, J. & Rassner, G., 1990, Structural analysis of melanocytic pigment nevi using epiluminescence microscopy. Review and personal experiences. Hautarzt, 41, 27–33. ***/li> ***li>Kreusch, J.F., 2002, Vascular patterns in skin tumors. Clin Dermatol, 20, 248–54. ***/li> ***li>Mogensen, M. & Jemec, G.B., 2007, Diagnosis of nonmelanoma skin cancer/ keratinocyte carcinoma: a review of diagnostic accuracy of nonmelanoma skin cancer diagnostic tests and technologies. Dermatol Surg, 33, 1158–74. ***/li> ***li>Pan Y., Chamberlain AJ., Bailey M., et al., 2008, Dermatoscopy aids in the diagnosis of the solitary red scaly patch or plaque-features distinguishing superficial basal cell carcinoma, intraepidermal carcinoma, and psoriasis. J Am Acad Dermatol,59, 268–274. ***/li> ***li>Peris, K., Micantonio, T., Piccolo, D. & Concetta, M., 2007a, Dermoscopic features of %%%mot_cle%%%. J Dtsch Dermatol Ges, 5, 970–6. ***/li> ***li>Pock, L., Drlik, L. & Hercogova, J., 2007, Dermatoscopy of pigmented %%%mot_cle%%% - A striking similarity to lentigo maligna. Int J Dermatol, 46, 414–16. ***/li> ***li>Schiffner, R., Schiffner-Rohe, J., Vogt, T., et al., 2000, Improvement of early recognition of lentigo maligna using dermatoscopy. J Am Acad Dermatol, 42, 25–32. ***/li> ***li>Stante, M., De Giorgi, V., Massi, D., Chiarugi, A. & Carli, P., 2004, Pigmented Bowen’s disease mimicking cutaneous melanoma: clinical and dermoscopic aspects. Dermatol Surg, 30, 541–4. ***/li> ***li>Stolz, W., Schiffner, R. & Burgdorf, W.H., 2002, Dermatoscopy for facial pigmented skin lesions. Clin Dermatol, 20, 276–8. ***/li> ***li>Zalaudek, I. & Argenziano, G., 2004, Glomerular vessels in Bowen’s disease. Br J Dermatol, 151, 720. ***/li> ***li>Zalaudek, I., Giacomel, J., Argenziano, G., et al., 2006b, Dermoscopy of facial nonpigmented %%%mot_cle%%%. Br J Dermatol, 155, 951–6. ***/li> ***li>Zalaudek, I., Giacomel, J., Schmid, K., et al., 2012, Dermatoscopy of facial %%%mot_cle%%%, intraepidermal carcinoma, and invasive squamous cell carcinoma: a pro- gression model. J Am Acad Dermatol, 66, 589–97. ***/li> ***/ol> ***!-- NewPP limit report Cached time: 20240908115617 Cache expiry: 0 Dynamic content: true Complications: [] [SMW] In‐text annotation parser time: 0.003 seconds CPU time usage: 0.231 seconds Real time usage: 0.276 seconds Preprocessor visited node count: 549/1000000 Post‐expand include size: 14518/3145728 bytes Template argument size: 486/3145728 bytes Highest expansion depth: 8/50 Expensive parser function count: 0/100 Unstrip recursion depth: 0/20 Unstrip post‐expand size: 2560/5000000 bytes --> ***!-- Transclusion expansion time report (%,ms,calls,template) 100.00% 249.053 1 -total 84.04% 209.296 1 Template:Page 14.42% 35.917 8 Template:YouTube 7.08% 17.644 1 Template:PageTOC 3.56% 8.855 1 Template:LinkToAskQueryForPageOwner 2.21% 5.511 1 Template:MetaElements 1.07% 2.656 3 Template:Clear 0.89% 2.210 1 Template:H2 --> ***/div>

***div class="mw-parser-output"> ***div style="display: none"> ***p> ***a href= "https://dermoscopedia.org/Glossary:Regression_structures" title="Glossary:Regression structures">Regression structures ***/a>, ***a href= "https://dermoscopedia.org/Glossary:Regression" title="Glossary:Regression">Regression ***/a>, ***a href= "https://dermoscopedia.org/Glossary:Blue_white_structures" title="Glossary:Blue white structures">Blue white structures ***/a>, ***a href= "https://dermoscopedia.org/Glossary:Blue_white_veil" title="Glossary:Blue %%%mot_cle%%%">Blue %%%mot_cle%%% ***/a> ***a href= "https://dermoscopedia.org/Cite:Blue_white_veil" title="Cite:Blue %%%mot_cle%%%">Blue %%%mot_cle%%% – cite! ***/a> ***a href= "https://dermoscopedia.org/Message:Blue_white_veil" title="Message:Blue %%%mot_cle%%%">Blue %%%mot_cle%%% (message) ***/a> ***a href= "https://dermoscopedia.org/Participate:Blue_white_veil" title="Participate:Blue %%%mot_cle%%%">Blue %%%mot_cle%%% – participate! ***/a> ***/p> ***div style="display: none"> User= ***/div> ***/div> ***div class="center"> ***div class="floatnone"> ***a href="https://dermoscopedia.org/File:Blue_whitish_veil_26.jpg" class="image"> ***img alt="Blue whitish veil 26.jpg" src="https://dermoscopedia.org/w/thumb.php?f=Blue_whitish_veil_26.jpg&width=600" decoding="async" width="600" height="450" srcset="https://dermoscopedia.org/w/thumb.php?f=Blue_whitish_veil_26.jpg&width=900 1.5x, https://dermoscopedia.org/w/thumb.php?f=Blue_whitish_veil_26.jpg&width=1200 2x" data-file-width="2732" data-file-height="2048" /> ***/a> ***/div> ***/div> ***div style="clear:both;"> ***/div> ***p>Blue-whitish veil is a blue and focal structureless zone with an overlying white “ground-glass” haze. It occurs in raised/palpable areas of a lesion (Braun et al., 2005). Histologically, it corresponds to heavily pigmented melanocytes and/or melanophages or melanin in the dermis (in melanocytic lesions), in combination with acanthosis and compact orthokeratosis (Massi et al., 2001b, 2001a). Blue-whitish veil is associated with melanoma, but can also be seen in Spitz/Reed nevi and in non-melanocytic lesions such as SK, BCC and pyogenic granuloma (Braun et al., 2005; Zaballos et al., 2009). ***br /> ***/p> ***div style="clear:both;"> ***/div> ***div class="center"> ***div class="floatnone"> ***a href="https://dermoscopedia.org/File:Blue_white_veil.jpg" class="image"> ***img alt="Blue %%%mot_cle%%%.jpg" src="https://dermoscopedia.org/w/thumb.php?f=Blue_white_veil.jpg&width=600" decoding="async" width="600" height="450" srcset="https://dermoscopedia.org/w/images/1/1e/Blue_white_veil.jpg 1.5x" data-file-width="737" data-file-height="553" /> ***/a> ***/div> ***/div> ***div style="clear:both;"> ***/div> ***p> ***br /> ***br /> ***/p> ***div style="font-size: 1.8rem; border-bottom: 1px solid #a2a9b1; width: 100%">References ***/div> ***div style="clear:both;"> ***/div> ***!-- NewPP limit report Cached time: 20240908115618 Cache expiry: 0 Dynamic content: true Complications: [] [SMW] In‐text annotation parser time: 0.006 seconds CPU time usage: 0.203 seconds Real time usage: 0.244 seconds Preprocessor visited node count: 411/1000000 Post‐expand include size: 6442/3145728 bytes Template argument size: 443/3145728 bytes Highest expansion depth: 7/50 Expensive parser function count: 0/100 Unstrip recursion depth: 0/20 Unstrip post‐expand size: 2049/5000000 bytes --> ***!-- Transclusion expansion time report (%,ms,calls,template) 100.00% 217.676 1 -total 97.90% 213.114 1 Template:Page 4.38% 9.528 1 Template:LinkToAskQueryForPageOwner 3.89% 8.461 1 Template:MetaElements 1.80% 3.915 1 Template:H2 1.04% 2.259 5 Template:Clear --> ***/div>

***div class="mw-parser-output"> ***div style="display: none"> ***p> ***a href= "https://dermoscopedia.org/Glossary:Amelanotic_melanoma" title="Glossary:Amelanotic melanoma">Amelanotic melanoma ***/a>, ***a href= "https://dermoscopedia.org/Glossary:Hypomelanotic_melanoma" title="Glossary:Hypomelanotic melanoma">Hypomelanotic melanoma ***/a>, ***a href= "https://dermoscopedia.org/Glossary:AHM" title="Glossary:AHM">AHM ***/a> ***a href= "https://dermoscopedia.org/Cite:Amelanotic_/_hypomelanotic_melanoma" title="Cite:Amelanotic / %%%mot_cle%%%">Amelanotic – cite! ***/a> ***a href= "https://dermoscopedia.org/Message:Amelanotic_/_hypomelanotic_melanoma" title="Message:Amelanotic / %%%mot_cle%%%">Amelanotic (message) ***/a> ***a href= "https://dermoscopedia.org/Participate:Amelanotic_/_hypomelanotic_melanoma" title="Participate:Amelanotic / %%%mot_cle%%%">Amelanotic – participate! ***/a> ***/p> ***div style="display: none"> User= ***/div> ***/div> ***p>Amelanotic/%%%mot_cle%%% (AHM) represents 2-8% of all melanomas ***sup id="cite_ref-PM15214897_1-0" class="reference"> ***a href="#cite_note-PM15214897-1">[1] ***/a> ***/sup>, but its real incidence is difficult to estimate because at the beginning it is often misdiagnosed and/or confused with inflammatory diseases, benign tumors and other malignant tumors (i.e. actinic keratosis, Bowen’s disease, basal cell carcinoma, keratoacanthoma, Merkel cell carcinoma, pyogenic granuloma, haemangioma, wart, etc). Definitely, if singly evaluated, the real prevalence of amelanotic melanoma is very low, since many of these tumors present a residual pigmentation that can be seen mostly at the periphery and should be considered hypomelanotic rather than amelanotic. The low or absent melanin production and the presence of regression are the two reasons why melanoma could be amelanotic or hypomelanotic; both these phenomena may even occur within the same lesion. ***/p> ***p>AHM has been classified in several variants: ***/p> ***ol> ***li>True amelanotic melanoma (melanoma not producing any trace of pigment) ***/li> ***li>Hypomelanotic melanoma (with low production of melanin that may extend to the entire lesion) ***/li> ***li>Partially pigmented melanoma(with a pigmentation occupying less than 25% of the lesion) ***/li> ***li>Regressive melanoma (in advanced stages of regression) ***/li> ***/ol> ***p>AHM often occurs in sun-exposed skin of older people ***sup id="cite_ref-PM15214897_1-1" class="reference"> ***a href="#cite_note-PM15214897-1">[1] ***/a> ***/sup> ***sup id="cite_ref-PM9220551_2-0" class="reference"> ***a href="#cite_note-PM9220551-2">[2] ***/a> ***/sup> and appears as a flat lesion, but more frequently as an elevated tumor, firm on palpation, and typified by rapid growth. This three characteristics (EFG: Elevation, Firmness, Growth) represent a precious clinical guide in melanomas without the classical ABCD clinical criteria ***sup id="cite_ref-PM12734497_3-0" class="reference"> ***a href="#cite_note-PM12734497-3">[3] ***/a> ***/sup> ***sup id="cite_ref-PM24825465_4-0" class="reference"> ***a href="#cite_note-PM24825465-4">[4] ***/a> ***/sup>. ***/p> ***p>By dermoscopy, the diagnostic clues for AHM are the vascular structures, often also difficult to detect because require a minimal pressure of the dermatoscope on the lesion to avoid the compression of the blood vessels ***sup id="cite_ref-PM18794455_5-0" class="reference"> ***a href="#cite_note-PM18794455-5">[5] ***/a> ***/sup>. As general rule, six main categories of vascular morphologies can be seen in tumoral lesions ***sup id="cite_ref-PM20708469_6-0" class="reference"> ***a href="#cite_note-PM20708469-6">[6] ***/a> ***/sup>: comma vessels (in intradermal nevi); dotted vessels (in melanocytic lesions, especially Spitz nevi and melanoma); linear–irregular vessels (in melanoma and other skin malignancies); arborizing vessels (in basal cell carcinoma); hairpin vessels (in keratinizing tumors, especially if surrounded by a whitish halo, and melanoma); and glomerular vessels (in Bowen’s disease). Moreover, also the following three specific global morphologies can be identified: crown vessels surrounding a white center, strawberry pattern and milky-red areas/globules ***sup id="cite_ref-PM15611426_7-0" class="reference"> ***a href="#cite_note-PM15611426-7">[7] ***/a> ***/sup> ***sup id="cite_ref-PM8655309_8-0" class="reference"> ***a href="#cite_note-PM8655309-8">[8] ***/a> ***/sup> ***sup id="cite_ref-9" class="reference"> ***a href="#cite_note-9">[9] ***/a> ***/sup> ***sup id="cite_ref-PM16319467_10-0" class="reference"> ***a href="#cite_note-PM16319467-10">[10] ***/a> ***/sup>. (Fig.1) ***/p> ***p> ***br /> ***/p> ***div style="float: left; margin: 0 2em;"> ***div class="image100"> ***a href="https://dermoscopedia.org/File:Fig._1_AHM.jpg" class="image" title="Figure 1: The most common vessels in dermoscopy."> ***img alt="Figure 1: The most common vessels in dermoscopy." src="https://dermoscopedia.org/w/thumb.php?f=Fig._1_AHM.jpg&width=1200" decoding="async" width="1200" height="758" srcset="https://dermoscopedia.org/w/images/a/a8/Fig._1_AHM.jpg 1.5x" data-file-width="1281" data-file-height="809" /> ***/a> ***br /> ***b>Figure 1: The most common vessels in dermoscopy. ***/b> ***/div> ***/div> ***div style="clear:both;"> ***/div> ***p>The most common vascular structures in AHM are dotted vessels, linear-irregular vessels, hairpin-irregular vessels, serpentine vessels or a combination of them (polymorphic vessels) ***sup id="cite_ref-PM18794455_5-1" class="reference"> ***a href="#cite_note-PM18794455-5">[5] ***/a> ***/sup>; also milky-red areas can be frequently visualized ***sup id="cite_ref-PM15214897_1-2" class="reference"> ***a href="#cite_note-PM15214897-1">[1] ***/a> ***/sup>.Morphology of vessels modifies during tumor growth. In fact, in early stages, the vessels often appear short and homogenous in shape, while in the advanced tumors, they appear longer and irregular. In thin melanoma (less than 0.5 mm Breslow thickness) the vessels are usually point-like with a rather regular arrangement. Tumors of 0.5–2mm thickness show both point-like and hairpin vessels, again with a regular arrangement. When thickness is over 2 mm the hairpin loops are more twisted, splintered and irregularly distributed, while melanomas of more than 3 mm of thickness develop polymorphic vessels. A multicenter retrospective study from Menzies et al. evaluated several amelanotic and %%%mot_cle%%%s to determine the diagnostic accuracy of various dermoscopic features ***sup id="cite_ref-PM18794455_5-2" class="reference"> ***a href="#cite_note-PM18794455-5">[5] ***/a> ***/sup>. Positive predictors included blue-white veil, scar-like depigmentation, multiple blue-gray dots, irregularly shaped depigmentation, irregular brown dots or globules, 5 to 6 colors within the same lesion and peripheral light brown structureless areas covering more than 10% of the lesion. Among vascular features, the positive predictors were predominant central vessels, milky red-areas, more than one shade of pink, and a combination of dotted and linear irregular vessels. The most significant negative predictors of melanoma were multiple (>3) milia-like cysts, the predominance of comma vessels with a regular arrangement, a symmetrical pigmentation, and regular and multiple blue-gray globules (Fig.2, 3,4,5,6,7). ***/p> ***p> ***br /> ***/p> ***div style="float: left; margin: 0 2em;"> ***div class="image100"> ***a href="https://dermoscopedia.org/File:Fig._2_AHM.jpg" class="image" title="Figure 2: Nodular %%%mot_cle%%% with hairpin, glomerular, linear irregular vessels (polymorphic vessels) and blue-white veil over a milky-red area."> ***img alt="Figure 2: Nodular %%%mot_cle%%% with hairpin, glomerular, linear irregular vessels (polymorphic vessels) and blue-white veil over a milky-red area." src="https://dermoscopedia.org/w/images/5/57/Fig._2_AHM.jpg" decoding="async" width="1200" height="904" data-file-width="1072" data-file-height="808" /> ***/a> ***br /> ***b>Figure 2: Nodular %%%mot_cle%%% with hairpin, glomerular, linear irregular vessels (polymorphic vessels) and blue-white veil over a milky-red area. ***/b> ***/div> ***/div> ***div style="clear:both;"> ***/div> ***p> ***br /> ***/p> ***div style="float: left; margin: 0 2em;"> ***div class="image100"> ***a href="https://dermoscopedia.org/File:Fig._3_AHM.jpg" class="image" title="Figure 3: Early invasive amelanotic melanoma with mainly dotted vessels irregularly distributed over a pinkish background."> ***img alt="Figure 3: Early invasive amelanotic melanoma with mainly dotted vessels irregularly distributed over a pinkish background." src="https://dermoscopedia.org/w/images/d/d6/Fig._3_AHM.jpg" decoding="async" width="1200" height="897" data-file-width="1076" data-file-height="804" /> ***/a> ***br /> ***b>Figure 3: Early invasive amelanotic melanoma with mainly dotted vessels irregularly distributed over a pinkish background. ***/b> ***/div> ***/div> ***div style="clear:both;"> ***/div> ***p> ***br /> ***/p> ***div style="float: left; margin: 0 2em;"> ***div class="image100"> ***a href="https://dermoscopedia.org/File:Fig._4_AHM.jpg" class="image" title="Figure 4: Early invasive amelanotic melanoma with dotted vessels regularly distributed over a pinkish background (Spitzoid- looking melanoma)."> ***img alt="Figure 4: Early invasive amelanotic melanoma with dotted vessels regularly distributed over a pinkish background (Spitzoid- looking melanoma)." src="https://dermoscopedia.org/w/images/d/df/Fig._4_AHM.jpg" decoding="async" width="1200" height="888" data-file-width="1077" data-file-height="797" /> ***/a> ***br /> ***b>Figure 4: Early invasive amelanotic melanoma with dotted vessels regularly distributed over a pinkish background (Spitzoid- looking melanoma). ***/b> ***/div> ***/div> ***div style="clear:both;"> ***/div> ***p> ***br /> ***/p> ***div style="float: left; margin: 0 2em;"> ***div class="image100"> ***a href="https://dermoscopedia.org/File:Fig._5_AHM.jpg" class="image" title="Figure 5: More advanced %%%mot_cle%%% with polymorphous vessels. Blue-white veil, and remnants of pigment network and brown globules are also detectable."> ***img alt="Figure 5: More advanced %%%mot_cle%%% with polymorphous vessels. Blue-white veil, and remnants of pigment network and brown globules are also detectable." src="https://dermoscopedia.org/w/images/d/d2/Fig._5_AHM.jpg" decoding="async" width="1200" height="900" data-file-width="1072" data-file-height="804" /> ***/a> ***br /> ***b>Figure 5: More advanced %%%mot_cle%%% with polymorphous vessels. Blue-white veil, and remnants of pigment network and brown globules are also detectable. ***/b> ***/div> ***/div> ***div style="clear:both;"> ***/div> ***p> ***br /> ***/p> ***div style="float: left; margin: 0 2em;"> ***div class="image100"> ***a href="https://dermoscopedia.org/File:Fig._6_AHM.jpg" class="image" title="Figure 6: Early invasive %%%mot_cle%%% with dotted vessels in the upper part and pigment network in the lower part of the lesion."> ***img alt="Figure 6: Early invasive %%%mot_cle%%% with dotted vessels in the upper part and pigment network in the lower part of the lesion." src="https://dermoscopedia.org/w/images/e/e0/Fig._6_AHM.jpg" decoding="async" width="1200" height="899" data-file-width="1077" data-file-height="807" /> ***/a> ***br /> ***b>Figure 6: Early invasive %%%mot_cle%%% with dotted vessels in the upper part and pigment network in the lower part of the lesion. ***/b> ***/div> ***/div> ***div style="clear:both;"> ***/div> ***p> ***br /> ***/p> ***div style="float: left; margin: 0 2em;"> ***div class="image100"> ***a href="https://dermoscopedia.org/File:Fig._7_AHM.jpg" class="image" title="Figure 7: Regressive %%%mot_cle%%% with linear-irregular vessels and a peripheral residual pigmentation."> ***img alt="Figure 7: Regressive %%%mot_cle%%% with linear-irregular vessels and a peripheral residual pigmentation." src="https://dermoscopedia.org/w/images/6/6a/Fig._7_AHM.jpg" decoding="async" width="1200" height="1022" data-file-width="1072" data-file-height="913" /> ***/a> ***br /> ***b>Figure 7: Regressive %%%mot_cle%%% with linear-irregular vessels and a peripheral residual pigmentation. ***/b> ***/div> ***/div> ***div style="clear:both;"> ***/div> ***p> ***br /> ***/p> ***p> ***br /> ***br /> ***/p> ***div style="font-size: 1.8rem; border-bottom: 1px solid #a2a9b1; width: 100%">References ***/div> ***div class="mw-references-wrap"> ***ol class="references"> ***li id="cite_note-PM15214897-1"> ***span class="mw-cite-backlink">↑ ***sup> ***a href="#cite_ref-PM15214897_1-0">1.0 ***/a> ***/sup> ***sup> ***a href="#cite_ref-PM15214897_1-1">1.1 ***/a> ***/sup> ***sup> ***a href="#cite_ref-PM15214897_1-2">1.2 ***/a> ***/sup> ***/span> ***span class="reference-text">Pizzichetta ***i>et al. ***/i>: Amelanotic/%%%mot_cle%%%: clinical and dermoscopic features. ***i>Br. J. Dermatol. ***/i> 2004;150:1117-24. PMID:  ***a class="external text" href="https://www.ncbi.nlm.nih.gov/pubmed/15214897">15214897 ***/a>. ***a class="external text" href="https://dx.doi.org/10.1111/j.1365-2133.2004.05928.x">DOI ***/a>. ***/span> ***/li> ***li id="cite_note-PM9220551-2"> ***span class="mw-cite-backlink"> ***a href="#cite_ref-PM9220551_2-0">↑ ***/a> ***/span> ***span class="reference-text">Adler & White: Amelanotic malignant melanoma. ***i>Semin Cutan Med Surg ***/i> 1997;16:122-30. PMID:  ***a class="external text" href="https://www.ncbi.nlm.nih.gov/pubmed/9220551">9220551 ***/a>. ***/span> ***/li> ***li id="cite_note-PM12734497-3"> ***span class="mw-cite-backlink"> ***a href="#cite_ref-PM12734497_3-0">↑ ***/a> ***/span> ***span class="reference-text">Chamberlain ***i>et al. ***/i>: Nodular melanoma: patients' perceptions of presenting features and implications for earlier detection. ***i>J. Am. Acad. Dermatol. ***/i> 2003;48:694-701. PMID:  ***a class="external text" href="https://www.ncbi.nlm.nih.gov/pubmed/12734497">12734497 ***/a>. ***a class="external text" href="https://dx.doi.org/10.1067/mjd.2003.216">DOI ***/a>. ***/span> ***/li> ***li id="cite_note-PM24825465-4"> ***span class="mw-cite-backlink"> ***a href="#cite_ref-PM24825465_4-0">↑ ***/a> ***/span> ***span class="reference-text">Stojkovic-Filipovic & Kittler: Dermatoscopy of amelanotic and %%%mot_cle%%%. ***i>J Dtsch Dermatol Ges ***/i> 2014;12:467-72. PMID:  ***a class="external text" href="https://www.ncbi.nlm.nih.gov/pubmed/24825465">24825465 ***/a>. ***a class="external text" href="https://dx.doi.org/10.1111/ddg.12368">DOI ***/a>. ***/span> ***/li> ***li id="cite_note-PM18794455-5"> ***span class="mw-cite-backlink">↑ ***sup> ***a href="#cite_ref-PM18794455_5-0">5.0 ***/a> ***/sup> ***sup> ***a href="#cite_ref-PM18794455_5-1">5.1 ***/a> ***/sup> ***sup> ***a href="#cite_ref-PM18794455_5-2">5.2 ***/a> ***/sup> ***/span> ***span class="reference-text">Menzies ***i>et al. ***/i>: Dermoscopic evaluation of amelanotic and %%%mot_cle%%%. ***i>Arch Dermatol ***/i> 2008;144:1120-7. PMID:  ***a class="external text" href="https://www.ncbi.nlm.nih.gov/pubmed/18794455">18794455 ***/a>. ***a class="external text" href="https://dx.doi.org/10.1001/archderm.144.9.1120">DOI ***/a>. ***/span> ***/li> ***li id="cite_note-PM20708469-6"> ***span class="mw-cite-backlink"> ***a href="#cite_ref-PM20708469_6-0">↑ ***/a> ***/span> ***span class="reference-text">Zalaudek ***i>et al. ***/i>: How to diagnose nonpigmented skin tumors: a review of vascular structures seen with dermoscopy: part I. Melanocytic skin tumors. ***i>J. Am. Acad. Dermatol. ***/i> 2010;63:361-74; quiz 375-6. PMID:  ***a class="external text" href="https://www.ncbi.nlm.nih.gov/pubmed/20708469">20708469 ***/a>. ***a class="external text" href="https://dx.doi.org/10.1016/j.jaad.2009.11.698">DOI ***/a>. ***/span> ***/li> ***li id="cite_note-PM15611426-7"> ***span class="mw-cite-backlink"> ***a href="#cite_ref-PM15611426_7-0">↑ ***/a> ***/span> ***span class="reference-text">Argenziano ***i>et al. ***/i>: Vascular structures in skin tumors: a dermoscopy study. ***i>Arch Dermatol ***/i> 2004;140:1485-9. PMID:  ***a class="external text" href="https://www.ncbi.nlm.nih.gov/pubmed/15611426">15611426 ***/a>. ***a class="external text" href="https://dx.doi.org/10.1001/archderm.140.12.1485">DOI ***/a>. ***/span> ***/li> ***li id="cite_note-PM8655309-8"> ***span class="mw-cite-backlink"> ***a href="#cite_ref-PM8655309_8-0">↑ ***/a> ***/span> ***span class="reference-text">Kreusch & Koch: [Incident light microscopic characterization of vascular patterns in skin tumors]. ***i>Hautarzt ***/i> 1996;47:264-72. PMID:  ***a class="external text" href="https://www.ncbi.nlm.nih.gov/pubmed/8655309">8655309 ***/a>. ***/span> ***/li> ***li id="cite_note-9"> ***span class="mw-cite-backlink"> ***a href="#cite_ref-9">↑ ***/a> ***/span> ***span class="reference-text">Zalaudek I, Argenziano G, Oliviero M, Rabinovitz H. Dermoscopy of non pigmented skin tumors. In: Thiers BH, Lang PG Jr, eds. Year book of dermatology and dermatologic surgery. Philadelphia: Elsevier Mosby, 2007 ***/span> ***/li> ***li id="cite_note-PM16319467-10"> ***span class="mw-cite-backlink"> ***a href="#cite_ref-PM16319467_10-0">↑ ***/a> ***/span> ***span class="reference-text">Zalaudek ***i>et al. ***/i>: Dermoscopy in general dermatology. ***i>Dermatology (Basel) ***/i> 2006;212:7-18. PMID:  ***a class="external text" href="https://www.ncbi.nlm.nih.gov/pubmed/16319467">16319467 ***/a>. ***a class="external text" href="https://dx.doi.org/10.1159/000089015">DOI ***/a>. ***/span> ***/li> ***/ol> ***/div> ***div style="clear:both;"> ***/div> ***!-- NewPP limit report Cached time: 20240908115619 Cache expiry: 0 Dynamic content: true Complications: [] [SMW] In‐text annotation parser time: 0.004 seconds CPU time usage: 0.229 seconds Real time usage: 0.270 seconds Preprocessor visited node count: 1243/1000000 Post‐expand include size: 18044/3145728 bytes Template argument size: 6074/3145728 bytes Highest expansion depth: 8/50 Expensive parser function count: 0/100 Unstrip recursion depth: 0/20 Unstrip post‐expand size: 8295/5000000 bytes --> ***!-- Transclusion expansion time report (%,ms,calls,template) 100.00% 240.244 1 -total 77.17% 185.395 1 Template:Page 12.31% 29.575 13 Template:PubMed 5.87% 14.095 1 Template:LinkToAskQueryForPageOwner 4.94% 11.874 1 Template:H2 4.26% 10.240 7 Template:File 2.70% 6.478 1 Template:MetaElements 1.47% 3.524 9 Template:Pubmed 1.39% 3.330 9 Template:Clear --> ***/div>

***div class="mw-parser-output"> ***div style="display: none"> ***p> ***a href= "https://dermoscopedia.org/Glossary:LPLK" title="Glossary:LPLK">LPLK ***/a>, ***a href= "https://dermoscopedia.org/Glossary:Lichen_planus_like_keratosis" title="Glossary:Lichen planus like keratosis">Lichen planus like keratosis ***/a> ***a href= "https://dermoscopedia.org/Cite:Lichen_planus-like_keratosis" title="Cite:Lichen planus-like keratosis">Lichen planus-like keratosis – cite! ***/a> ***a href= "https://dermoscopedia.org/Message:Lichen_planus-like_keratosis" title="Message:Lichen planus-like keratosis">Lichen planus-like keratosis (message) ***/a> ***a href= "https://dermoscopedia.org/Participate:Lichen_planus-like_keratosis" title="Participate:Lichen planus-like keratosis">Lichen planus-like keratosis – participate! ***/a> ***/p> ***div style="display: none"> User= ***/div> ***/div> ***p>Lichen planus-like keratosis, also known as LPLK and lichenoid keratosis, is one of the common benign neoplasms of the skin. It is believed to be either a seborrheic keratosis or a solar lentigo that is undergoing regression. Supporting evidence has been published beginning with Mehregan’s findings of the presence of lentiginous epidermal hyperplasia in lesions interpreted as LPLK ***sup id="cite_ref-PM127813_1-0" class="reference"> ***a href="#cite_note-PM127813-1">[1] ***/a> ***/sup>. Further supporting evidence can be found by Laur, et al who in 1981 published a detailed clinical-histopathologic correlation in the JAAD ***sup id="cite_ref-PM7217401_2-0" class="reference"> ***a href="#cite_note-PM7217401-2">[2] ***/a> ***/sup>. In addition, Goldenhersh et al ***sup id="cite_ref-PM3771875_3-0" class="reference"> ***a href="#cite_note-PM3771875-3">[3] ***/a> ***/sup>, described performing biopsies of lentigines on two instances. The first being a biopsy of a solar lentigo and 5 years later, after the lesion had demonstrated a clinical change into a solitary %%%mot_cle%%%‐like keratosis. ***/p> ***div id="toc" class="toc" role="navigation" aria-labelledby="mw-toc-heading"> ***input type="checkbox" role="button" id="toctogglecheckbox" class="toctogglecheckbox" style="display:none" /> ***div class="toctitle" lang="en" dir="ltr"> ***h2 id="mw-toc-heading">Contents ***/h2> ***span class="toctogglespan"> ***label class="toctogglelabel" for="toctogglecheckbox"> ***/label> ***/span> ***/div> ***ul> ***li class="toclevel-1 tocsection-1"> ***a href="#Clinical_and_Histologic_Appearance"> ***span class="tocnumber">1 ***/span> ***span class="toctext">Clinical and Histologic Appearance ***/span> ***/a> ***ul> ***li class="toclevel-2 tocsection-2"> ***a href="#Early_Stage"> ***span class="tocnumber">1.1 ***/span> ***span class="toctext">Early Stage ***/span> ***/a> ***/li> ***li class="toclevel-2 tocsection-3"> ***a href="#Intermediate_Stage"> ***span class="tocnumber">1.2 ***/span> ***span class="toctext">Intermediate Stage ***/span> ***/a> ***/li> ***li class="toclevel-2 tocsection-4"> ***a href="#Late_Stage"> ***span class="tocnumber">1.3 ***/span> ***span class="toctext">Late Stage ***/span> ***/a> ***/li> ***/ul> ***/li> ***li class="toclevel-1 tocsection-5"> ***a href="#Dermatoscopic_Criteria"> ***span class="tocnumber">2 ***/span> ***span class="toctext">Dermatoscopic Criteria ***/span> ***/a> ***ul> ***li class="toclevel-2 tocsection-6"> ***a href="#Early_Stage_LPLK"> ***span class="tocnumber">2.1 ***/span> ***span class="toctext">Early Stage LPLK ***/span> ***/a> ***/li> ***li class="toclevel-2 tocsection-7"> ***a href="#Intermediate_Stage_LPL"> ***span class="tocnumber">2.2 ***/span> ***span class="toctext">Intermediate Stage LPL ***/span> ***/a> ***/li> ***li class="toclevel-2 tocsection-8"> ***a href="#Late_Stage_LPLK"> ***span class="tocnumber">2.3 ***/span> ***span class="toctext">Late Stage LPLK ***/span> ***/a> ***/li> ***/ul> ***/li> ***li class="toclevel-1 tocsection-9"> ***a href="#Differential_diagnosis"> ***span class="tocnumber">3 ***/span> ***span class="toctext">Differential diagnosis ***/span> ***/a> ***/li> ***/ul> ***/div> ***h2> ***span class="mw-headline" id="Clinical_and_Histologic_Appearance">Clinical and Histologic Appearance ***/span> ***/h2> ***p>Lichen planus-like keratosis is a great masquerader with a differential diagnosis including basal cell carcinoma, squamous cell carcinoma and melanoma. The wide differential diagnosis is due to the extreme variability in characteristic appearance with many pigmentation and morphologic possibilities. The clinical appearance depends on its stage of evolution. ***/p> ***p>The lesion can appear as a macule or papule that is pink, pinkish brown, pinkish orange, rust colored, purplish brown, dusky violaceous or blue-gray to black. Some lesions are characterized by a velvety appearance, some have a fine scale, while others have accentuated skin markings. Lesions can be solitary or in some cases multiple. ***/p> ***p> ***br /> ***/p> ***h3> ***span class="mw-headline" id="Early_Stage">Early Stage ***/span> ***/h3> ***p>The histologic features of early stage of LPLK include hypergranulosis, epidermal hyperplasia, a few necrotic keratinocytes and a superficial, bandlike lichenoid infiltrate. Clinically these lesions appear as pink macules or papules and may be difficult to distinguish from basal cell carcinoma or squamous cell carcinoma. ***/p> ***p> ***br /> ***/p> ***h3> ***span class="mw-headline" id="Intermediate_Stage">Intermediate Stage ***/span> ***/h3> ***p>Histologically intermediate stage LPLK is characterized by melanophages, inflammatory cells and fibrosis, with features consistent with either a lentigo or a seborrheic keratosis. In some cases, clinically, the lesion may be difficult to distinguish from melanoma (melanoma on sun-damaged skin, lentiginous melanoma, lentigo maligna melanoma). ***/p> ***p> ***br /> ***/p> ***h3> ***span class="mw-headline" id="Late_Stage">Late Stage ***/span> ***/h3> ***p>Late stage LPLK is characterized histologically by papillary fibrosis, telangiectasias, and melanophages. The lesions have a more blue-gray to black clinical appearance and may be difficult to distinguish from melanoma. ***/p> ***h2> ***span class="mw-headline" id="Dermatoscopic_Criteria">Dermatoscopic Criteria ***/span> ***/h2> ***p>Dermoscopy allows the detailed visualization of the structures found within the epidermis, dermoepidermal junction and papillary dermis. This information creates a bridge between the clinical and histologic correlates, thus narrowing the differential and allowing for a more accurate assessment of the lesion. ***/p> ***p> ***br /> ***/p> ***h3> ***span class="mw-headline" id="Early_Stage_LPLK">Early Stage LPLK ***/span> ***/h3> ***p>Lichen planus-like keratosis in its early stage is characterized by polymorphous vessels: dotted vessels and short thin vessels that are either linear, slightly curved or serpentine in appearance. The lesions may appear structureless, pink-white with an orange or yellow hue, colors that are not bright nor saturated, borders that are scalloped and a scale. Shiny white structures (SWS, or crystalline structures) are commonly seen with LPLK, that appear as white strands or blotches. Rosettes can also be seen with LPLKs that coincide with actinically damaged skin. ***/p> ***p>Here are two examples of early stage LPLKs: ***/p> ***div class="center"> ***div class="floatnone"> ***a href="https://dermoscopedia.org/File:Early_stage_lplk_2.jpg" class="image"> ***img alt="Early stage lplk 2.jpg" src="https://dermoscopedia.org/w/thumb.php?f=Early_stage_lplk_2.jpg&width=600" decoding="async" width="600" height="400" class="img-fluid" srcset="https://dermoscopedia.org/w/thumb.php?f=Early_stage_lplk_2.jpg&width=900 1.5x, https://dermoscopedia.org/w/thumb.php?f=Early_stage_lplk_2.jpg&width=1200 2x" data-file-width="6000" data-file-height="4000" /> ***/a> ***/div> ***/div> ***div style="clear:both;"> ***/div> ***div class="center"> ***div class="floatnone"> ***a href="https://dermoscopedia.org/File:Early_stage_LPLK.jpg" class="image"> ***img alt="Early stage LPLK.jpg" src="https://dermoscopedia.org/w/thumb.php?f=Early_stage_LPLK.jpg&width=600" decoding="async" width="600" height="803" class="img-fluid" srcset="https://dermoscopedia.org/w/thumb.php?f=Early_stage_LPLK.jpg&width=900 1.5x, https://dermoscopedia.org/w/thumb.php?f=Early_stage_LPLK.jpg&width=1200 2x" data-file-width="1936" data-file-height="2592" /> ***/a> ***/div> ***/div> ***div style="clear:both;"> ***/div> ***h3> ***span class="mw-headline" id="Intermediate_Stage_LPL">Intermediate Stage LPL ***/span> ***/h3> ***p>Lichen planus-like keratosis in the intermediate phase is characterized by two patterns. The first pattern depicts the dermoscopic features of a solar lentigo (fine lines parallel; straight, slightly curved, long or short, with sharply demarcated and scalloped borders) with the addition of regression structures: focal gray dots/granules. ***br /> ***br /> ***/p> ***div class="center"> ***div class="floatnone"> ***a href="https://dermoscopedia.org/File:INTERMEDIATE_lplk_sl.jpg" class="image"> ***img alt="INTERMEDIATE lplk sl.jpg" src="https://dermoscopedia.org/w/thumb.php?f=INTERMEDIATE_lplk_sl.jpg&width=600" decoding="async" width="600" height="803" class="img-fluid" srcset="https://dermoscopedia.org/w/thumb.php?f=INTERMEDIATE_lplk_sl.jpg&width=900 1.5x, https://dermoscopedia.org/w/thumb.php?f=INTERMEDIATE_lplk_sl.jpg&width=1200 2x" data-file-width="1936" data-file-height="2592" /> ***/a> ***/div> ***/div> ***div style="clear:both;"> ***/div> ***p>The second pattern portrays the features of a seborrheic keratosis (borders sharply demarcated, milia-like cysts, comedo-like openings, fissures, ridges, looped vessels and fine vessels surrounded by a halo) with the addition of regression structures: focal gray dots/granules. ***br /> ***br /> ***/p> ***div class="center"> ***div class="floatnone"> ***a href="https://dermoscopedia.org/File:Intermediate_LPLK_SK.jpg" class="image"> ***img alt="Intermediate LPLK SK.jpg" src="https://dermoscopedia.org/w/thumb.php?f=Intermediate_LPLK_SK.jpg&width=600" decoding="async" width="600" height="803" class="img-fluid" srcset="https://dermoscopedia.org/w/thumb.php?f=Intermediate_LPLK_SK.jpg&width=900 1.5x, https://dermoscopedia.org/w/thumb.php?f=Intermediate_LPLK_SK.jpg&width=1200 2x" data-file-width="1936" data-file-height="2592" /> ***/a> ***/div> ***/div> ***div style="clear:both;"> ***/div> ***h3> ***span class="mw-headline" id="Late_Stage_LPLK">Late Stage LPLK ***/span> ***/h3> ***p>Lichen planus-like keratosis in the late phase is characterized by scattered clumps of pigment with diffuse gray dots/granules or gray dots/granules that form what is known as a diffuse granular pattern, and borders that are often scalloped or have a moth-eaten appearance. ***/p> ***div class="center"> ***div class="floatnone"> ***a href="https://dermoscopedia.org/File:Late_stage_LPLK3.jpg" class="image"> ***img alt="Late stage LPLK3.jpg" src="https://dermoscopedia.org/w/thumb.php?f=Late_stage_LPLK3.jpg&width=600" decoding="async" width="600" height="443" class="img-fluid" srcset="https://dermoscopedia.org/w/images/4/4e/Late_stage_LPLK3.jpg 1.5x" data-file-width="850" data-file-height="627" /> ***/a> ***/div> ***/div> ***div style="clear:both;"> ***/div> ***h2> ***span class="mw-headline" id="Differential_diagnosis">Differential diagnosis ***/span> ***/h2> ***p>In a recent study for the US ***sup id="cite_ref-PM_30450536_4-0" class="reference"> ***a href="#cite_note-PM_30450536-4">[4] ***/a> ***/sup> LPLKs were compared with non-LPLK cutaneous lesions. LPLKs had the clinical differential diagnosis of basal cell carcinoma, squamous cell carcinoma, neavus, melanoma, seborrehic keratosis, lentigo, and actinic keratosis. Dermoscopic features that were found to distinguish LPLKs from other lesions include: Overall organized dermoscopic structures, scale, orange color, coarse +/- fine granules and peppering as the only feature present. LPLKs were less likely to have moth-eaten borders and irregular dots compared to the other lesions. ***/p> ***p> ***br /> ***br /> ***/p> ***div style="font-size: 1.8rem; border-bottom: 1px solid #a2a9b1; width: 100%">References: ***/div> ***div style="clear:both;"> ***/div> ***div class="mw-references-wrap"> ***ol class="references"> ***li id="cite_note-PM127813-1"> ***span class="mw-cite-backlink"> ***a href="#cite_ref-PM127813_1-0">↑ ***/a> ***/span> ***span class="reference-text">Mehregan: Lentigo senilis and its evolutions. ***i>J. Invest. Dermatol. ***/i> 1975;65:429-33. PMID:  ***a class="external text" href="https://www.ncbi.nlm.nih.gov/pubmed/127813">127813 ***/a>. ***/span> ***/li> ***li id="cite_note-PM7217401-2"> ***span class="mw-cite-backlink"> ***a href="#cite_ref-PM7217401_2-0">↑ ***/a> ***/span> ***span class="reference-text">Laur ***i>et al. ***/i>: Lichen planus-like keratosis. A clinicohistopathologic correlation. ***i>J. Am. Acad. Dermatol. ***/i> 1981;4:329-36. PMID:  ***a class="external text" href="https://www.ncbi.nlm.nih.gov/pubmed/7217401">7217401 ***/a>. ***/span> ***/li> ***li id="cite_note-PM3771875-3"> ***span class="mw-cite-backlink"> ***a href="#cite_ref-PM3771875_3-0">↑ ***/a> ***/span> ***span class="reference-text">Goldenhersh ***i>et al. ***/i>: Documented evolution of a solar lentigo into a solitary %%%mot_cle%%%-like keratosis. ***i>J. Cutan. Pathol. ***/i> 1986;13:308-11. PMID:  ***a class="external text" href="https://www.ncbi.nlm.nih.gov/pubmed/3771875">3771875 ***/a>. ***/span> ***/li> ***li id="cite_note-PM_30450536-4"> ***span class="mw-cite-backlink"> ***a href="#cite_ref-PM_30450536_4-0">↑ ***/a> ***/span> ***span class="reference-text">Liopyris ***i>et al. ***/i>: Clinical and dermoscopic features associated with %%%mot_cle%%%-like keratoses that undergo skin biopsy: A single-center, observational study. ***i>Australas. J. Dermatol. ***/i> 2018;. PMID:  ***a class="external text" href="https://www.ncbi.nlm.nih.gov/pubmed/30450536">30450536 ***/a>. ***a class="external text" href="https://dx.doi.org/10.1111/ajd.12955">DOI ***/a>. ***/span> ***/li> ***/ol> ***/div> ***!-- NewPP limit report Cached time: 20240908115620 Cache expiry: 0 Dynamic content: true Complications: [] [SMW] In‐text annotation parser time: 0 seconds CPU time usage: 0.171 seconds Real time usage: 0.212 seconds Preprocessor visited node count: 688/1000000 Post‐expand include size: 9046/3145728 bytes Template argument size: 1162/3145728 bytes Highest expansion depth: 7/50 Expensive parser function count: 0/100 Unstrip recursion depth: 0/20 Unstrip post‐expand size: 2393/5000000 bytes --> ***!-- Transclusion expansion time report (%,ms,calls,template) 100.00% 195.250 1 -total 76.54% 149.453 1 Template:Page 9.02% 17.613 4 Template:PubMed 3.88% 7.568 1 Template:MetaElements 2.96% 5.779 1 Template:LinkToAskQueryForPageOwner 1.74% 3.403 4 Template:Pubmed 1.66% 3.238 1 Template:H2 1.46% 2.843 7 Template:Clear --> ***/div>

***div class="mw-parser-output"> ***div style="display: none"> ***p> ***a href= "https://dermoscopedia.org/Glossary:Psoriasis" title="Glossary:Psoriasis">Psoriasis ***/a> ***a href= "https://dermoscopedia.org/Cite:Psoriasis" title="Cite:Psoriasis">Psoriasis – cite! ***/a> ***a href= "https://dermoscopedia.org/Message:Psoriasis" title="Message:Psoriasis">Psoriasis (message) ***/a> ***a href= "https://dermoscopedia.org/Participate:Psoriasis" title="Participate:Psoriasis">Psoriasis – participate! ***/a> ***/p> ***div style="display: none"> User= ***/div> ***/div> ***p>Dotted vessels represent the most frequent dermoscopic feature of Psoriasis, being present in every single psoriatic plaque. Detection of any other morphologic type of vessels excludes the diagnosis of PP. ***sup id="cite_ref-PM22296226_1-0" class="reference"> ***a href="#cite_note-PM22296226-1">[1] ***/a> ***/sup> The term “red globules” has also been used to describe the same dermoscopic feature. ***sup id="cite_ref-PM12920364_2-0" class="reference"> ***a href="#cite_note-PM12920364-2">[2] ***/a> ***/sup> Distinction between dots and globules is based on the diameter of the structure (dots are smaller), and it is important in dermoscopy of melanocytic tumors. In %%%mot_cle%%% both terms may be used, since the roundish vascular structures can be of various diameters, although they are usually of similar size within a given lesion. Under higher magnifications (x100-x400), the psoriatic vessels appear as dilated, elongated, and convoluted capillaries. ***sup id="cite_ref-PM12037454_3-0" class="reference"> ***a href="#cite_note-PM12037454-3">[3] ***/a> ***/sup> Histopathologically, red dots correspond to the loops of vertically arranged vessels within the elongated dermal papillae. ***/p> ***div class="thumb tright"> ***div class="thumbinner" style="width:302px;"> ***a href="https://dermoscopedia.org/File:Inflam.002.jpeg" class="image"> ***img alt="" src="https://dermoscopedia.org/w/thumb.php?f=Inflam.002.jpeg&width=300" decoding="async" width="300" height="225" class="thumbimage" srcset="https://dermoscopedia.org/w/thumb.php?f=Inflam.002.jpeg&width=450 1.5x, https://dermoscopedia.org/w/thumb.php?f=Inflam.002.jpeg&width=600 2x" data-file-width="1024" data-file-height="768" /> ***/a> ***div class="thumbcaption"> ***div class="magnify"> ***a href="https://dermoscopedia.org/File:Inflam.002.jpeg" class="internal" title="Enlarge"> ***/a> ***/div>A psoriatic lesion covered by thick scales ***/div> ***/div> ***/div> ***div class="thumb tright"> ***div class="thumbinner" style="width:302px;"> ***a href="https://dermoscopedia.org/File:Inflam.001.jpeg" class="image"> ***img alt="" src="https://dermoscopedia.org/w/thumb.php?f=Inflam.001.jpeg&width=300" decoding="async" width="300" height="225" class="thumbimage" srcset="https://dermoscopedia.org/w/thumb.php?f=Inflam.001.jpeg&width=450 1.5x, https://dermoscopedia.org/w/thumb.php?f=Inflam.001.jpeg&width=600 2x" data-file-width="1024" data-file-height="768" /> ***/a> ***div class="thumbcaption"> ***div class="magnify"> ***a href="https://dermoscopedia.org/File:Inflam.001.jpeg" class="internal" title="Enlarge"> ***/a> ***/div>Dotted vessels of psoriasis ***/div> ***/div> ***/div> ***p>Important for differential diagnosis, the uniform distribution of the red dots within the lesion represents the dermoscopic hallmark of psoriasis. Dotted vessels may be detected in several inflammatory dermatoses, but no other disease exhibits the symmetrical and homogenous arrangement of vessels all over the lesion that characterizes psoriatic plaques, unless thick superficial scales cover them. ***sup id="cite_ref-PM22296226_1-1" class="reference"> ***a href="#cite_note-PM22296226-1">[1] ***/a> ***/sup> Scales removal will bring to light the characteristic vascular pattern of %%%mot_cle%%% possibly together with tiny red blood drops, which can be characterized as the dermoscopic “Auspitz sign”. A specific feature for the diagnosis of psoriasis is the sign of red globular rings, described by Vazquez-Lopez et al. If present, the red globules are arranged in irregular circles or rings. But even if highly specific, this sign is only seen in a minority of psoriatic lesions. Other types of vessels distribution are extremely rare in psoriasis. ***sup id="cite_ref-PM22296226_1-2" class="reference"> ***a href="#cite_note-PM22296226-1">[1] ***/a> ***/sup> ***sup id="cite_ref-PM18087028_4-0" class="reference"> ***a href="#cite_note-PM18087028-4">[4] ***/a> ***/sup> In addition, light red background color and white superficial scales are two common dermoscopic criteria of plaque psoriasis. In differential diagnosis of erythematosquamous dermatoses, scale color is of particular value: Yellow scales are a negative predictor of plaque %%%mot_cle%%% therefore argueing for the presence of dermatitis. ***sup id="cite_ref-PM22296226_1-3" class="reference"> ***a href="#cite_note-PM22296226-1">[1] ***/a> ***/sup> Dermoscopic findings of psoriasis may vary dependent of the body site and the various amounts of scaling. In psoriatic balanitis and inverse psoriasis lesions that lack scaling, the regularly distributed red dots are prominent. Contrariwise, in scalp or palmoplantar %%%mot_cle%%% thick hyperkeratotic plaques hide the typical vascular structures, which may be recognized after removal of the scales. ***sup id="cite_ref-PM21155753_5-0" class="reference"> ***a href="#cite_note-PM21155753-5">[5] ***/a> ***/sup> ***/p> ***dl> ***dt>Dermoscopic transformation of psoriatic plaques under treatment ***/dt> ***/dl> ***p>Regular dermoscopic examination is of avail in patients under treatment with topical steroids or systemic biological agents, because additional morphologic information might be helpful for early detection of a relapse. Additionally, steroid-induced skin atrophy is earlier detected by dermoscopy (by revealing characteristic linear vessels) than in the clinical setting. ***sup id="cite_ref-PM15523365_6-0" class="reference"> ***a href="#cite_note-PM15523365-6">[6] ***/a> ***/sup> ***br /> ***/p> ***div style="max-width:400px"> ***p> ***div class="videoWrapper"> ***iframe width="400" height="300" src="https://www.youtube.com/embed/mOt8A41OZXA" frameborder="0" allowfullscreen> ***/iframe> ***/div> ***br /> ***/p> ***/div> ***p> ***br /> ***br /> ***/p> ***div style="font-size: 1.8rem; border-bottom: 1px solid #a2a9b1; width: 100%">References ***/div> ***div class="mw-references-wrap"> ***ol class="references"> ***li id="cite_note-PM22296226-1"> ***span class="mw-cite-backlink">↑ ***sup> ***a href="#cite_ref-PM22296226_1-0">1.0 ***/a> ***/sup> ***sup> ***a href="#cite_ref-PM22296226_1-1">1.1 ***/a> ***/sup> ***sup> ***a href="#cite_ref-PM22296226_1-2">1.2 ***/a> ***/sup> ***sup> ***a href="#cite_ref-PM22296226_1-3">1.3 ***/a> ***/sup> ***/span> ***span class="reference-text">Lallas ***i>et al. ***/i>: Accuracy of dermoscopic criteria for the diagnosis of %%%mot_cle%%% dermatitis, lichen planus and pityriasis rosea. ***i>Br. J. Dermatol. ***/i> 2012;166:1198-205. PMID:  ***a class="external text" href="https://www.ncbi.nlm.nih.gov/pubmed/22296226">22296226 ***/a>. ***a class="external text" href="https://dx.doi.org/10.1111/j.1365-2133.2012.10868.x">DOI ***/a>. ***/span> ***/li> ***li id="cite_note-PM12920364-2"> ***span class="mw-cite-backlink"> ***a href="#cite_ref-PM12920364_2-0">↑ ***/a> ***/span> ***span class="reference-text">Vázquez-López ***i>et al. ***/i>: Dermoscopic features of plaque psoriasis and lichen planus: new observations. ***i>Dermatology (Basel) ***/i> 2003;207:151-6. PMID:  ***a class="external text" href="https://www.ncbi.nlm.nih.gov/pubmed/12920364">12920364 ***/a>. ***a class="external text" href="https://dx.doi.org/71785">DOI ***/a>. ***/span> ***/li> ***li id="cite_note-PM12037454-3"> ***span class="mw-cite-backlink"> ***a href="#cite_ref-PM12037454_3-0">↑ ***/a> ***/span> ***span class="reference-text">De Angelis ***i>et al. ***/i>: Videocapillaroscopic findings in the microcirculation of the psoriatic plaque. ***i>Dermatology (Basel) ***/i> 2002;204:236-9. PMID:  ***a class="external text" href="https://www.ncbi.nlm.nih.gov/pubmed/12037454">12037454 ***/a>. ***a class="external text" href="https://dx.doi.org/57888">DOI ***/a>. ***/span> ***/li> ***li id="cite_note-PM18087028-4"> ***span class="mw-cite-backlink"> ***a href="#cite_ref-PM18087028_4-0">↑ ***/a> ***/span> ***span class="reference-text">Vázquez-López ***i>et al. ***/i>: A dermoscopy subpattern of plaque-type psoriasis: red globular rings. ***i>Arch Dermatol ***/i> 2007;143:1612. PMID:  ***a class="external text" href="https://www.ncbi.nlm.nih.gov/pubmed/18087028">18087028 ***/a>. ***a class="external text" href="https://dx.doi.org/10.1001/archderm.143.12.1612">DOI ***/a>. ***/span> ***/li> ***li id="cite_note-PM21155753-5"> ***span class="mw-cite-backlink"> ***a href="#cite_ref-PM21155753_5-0">↑ ***/a> ***/span> ***span class="reference-text">Kim ***i>et al. ***/i>: Dermoscopy can be useful in differentiating scalp psoriasis from seborrhoeic dermatitis. ***i>Br. J. Dermatol. ***/i> 2011;164:652-6. PMID:  ***a class="external text" href="https://www.ncbi.nlm.nih.gov/pubmed/21155753">21155753 ***/a>. ***a class="external text" href="https://dx.doi.org/10.1111/j.1365-2133.2010.10180.x">DOI ***/a>. ***/span> ***/li> ***li id="cite_note-PM15523365-6"> ***span class="mw-cite-backlink"> ***a href="#cite_ref-PM15523365_6-0">↑ ***/a> ***/span> ***span class="reference-text">Vázquez-López & Marghoob: Dermoscopic assessment of long-term topical therapies with potent steroids in chronic psoriasis. ***i>J. Am. Acad. Dermatol. ***/i> 2004;51:811-3. PMID:  ***a class="external text" href="https://www.ncbi.nlm.nih.gov/pubmed/15523365">15523365 ***/a>. ***a class="external text" href="https://dx.doi.org/10.1016/j.jaad.2004.05.020">DOI ***/a>. ***/span> ***/li> ***/ol> ***/div> ***div style="clear:both;"> ***/div> ***!-- NewPP limit report Cached time: 20240908115621 Cache expiry: 0 Dynamic content: true Complications: [] [SMW] In‐text annotation parser time: 0.005 seconds CPU time usage: 0.187 seconds Real time usage: 0.226 seconds Preprocessor visited node count: 800/1000000 Post‐expand include size: 10034/3145728 bytes Template argument size: 1830/3145728 bytes Highest expansion depth: 8/50 Expensive parser function count: 0/100 Unstrip recursion depth: 0/20 Unstrip post‐expand size: 5865/5000000 bytes --> ***!-- Transclusion expansion time report (%,ms,calls,template) 100.00% 197.810 1 -total 70.90% 140.242 1 Template:Page 15.07% 29.802 9 Template:PubMed 7.13% 14.110 1 Template:H2 6.28% 12.423 1 Template:YouTube 3.76% 7.442 1 Template:MetaElements 2.70% 5.345 1 Template:LinkToAskQueryForPageOwner 2.05% 4.047 6 Template:Pubmed 0.91% 1.804 2 Template:Clear --> ***/div>