AAD
Author: Willhemenia Loremipsum Special session: Lorem ipsum dolor sit amet Category: Lorem ipsum View all results

Please login or create an account. If you do not have access to this content, you will be shown a 30 second preview and licensing options.

  • Presentation

Dermoscopy for the Non-Dermoscopist: Pigmented Facial Lesions

Description

In this presentation led by Dr. Kendall Buchanan from the Medical College of Georgia, the focus is on the diagnosis of pigmented facial lesions, which are challenging due to the thin epidermis and chronic sun damage. The discussion revolves around various types of lesions, primarily flat pigmented ones, including lentigo, seborrheic keratosis, pigmented basal cell carcinoma, and pigmented actinic keratosis. Key dermoscopic features are emphasized, such as the observation of follicular openings, pigmentation patterns, and structureless areas. The presentation highlights the unique aspects of lentigo maligna, notably its isolated nature and distinctive pigmentation criteria known as the Stoltz criteria. It also differentiates between various lesions by focusing on specific attributes and features, such as scale, color uniformity, and border irregularities. The conclusions stress the importance of using clinical skills alongside dermoscopy and recognizing specific patterns that indicate different types of lesions, all while sharing valuable patient cases to illustrate these points effectively.

View more

Conclusions

  • Dermatoscopy is crucial for diagnosing pigmented facial lesions such as lentigo maligna.
  • Facial pigmented lesions exhibit a pseudonetwork rather than a classic pigment network, complicating visual assessment.
  • Key dermatoscopic features for identifying lentigo maligna include asymmetry, irregular pigmentation, and dark structureless areas.
  • A progression model for lentigo maligna includes the appearance of hyperpigmented follicular openings, rhomboidal structures, and obliteration of hair follicles.
  • Dermatoscopic criteria for lentigo maligna have been updated to include perifollicular linear projections and asymmetric pigmentation around hair follicles.
  • Pigmented actinic keratosis can mimic lentigo maligna, highlighting the importance of identifying specific dermatoscopic characteristics such as scale and rough texture.
  • Differentiation of facial lesions requires attention to detail, including recognizing classic features for each type of lesion, like scalloped borders for seborrheic keratosis.
  • Stolz W, Schiffner R, Burgdorf WH. Dermatoscopy for facial pigmented skin lesions. Clin Dermatol. 2002 May-Jun;20(3):276-8. doi: 10.1016/s0738-081x(02)00221-3. PMID: 12074867.
  • Schiffner R, Schiffner-Rohe J, Vogt T, Landthaler M, Wlotzke U, Cognetta AB, Stolz W. Improvement of early recognition of lentigo maligna using dermatoscopy. J Am Acad Dermatol. 2000 Jan;42(1 Pt 1):25-32. doi: 10.1016/s0190-9622(00)90005-7. PMID: 10607316.
  • Navarrete-Dechent C, Jaimes N, Dusza SW et al. Perifollicular linear projections: A dermatoscopic criterion for the diagnosis of lentigo maligna on the face. J Am Acad Dermatol. 2024 Jan;90(1):52-57. doi: 10.1016/j.jaad.2023.07.1036. PMID: 37634737; PMCID: PMC11326498.
  • Pralong P, Bathelier E, Dalle S, Poulalhon N, Debarbieux S, Thomas L. Dermoscopy of lentigo maligna melanoma: report of 125 cases. Br J Dermatol. 2012;167(2):280-7. doi: 10.1111/j.1365-2133.2012.10932.x.
  • Pock L, Drlík L, Hercogová J. Dermatoscopy of pigmented actinic keratosis -- a striking similarity to lentigo maligna. Int J Dermatol. 2007 Apr;46(4):414-6. doi: 10.1111/j.1365-4632.2006.03052.x. PMID: 17442088.
  • Lallas A, Tschandl P, Kyrgidis A, Stolz W, Rabinovitz H, Cameron A, Gourhant JY, Giacomel J, Kittler H, Muir J, Argenziano G, Hofmann-Wellenhof R, Zalaudek I. Dermoscopic clues to differentiate facial lentigo maligna from pigmented actinic keratosis. Br J Dermatol. 2016 May;174(5):1079-85. doi: 10.1111/bjd.14355. PMID: 26784739.
  • Tschandl P, Gambardella A, Boespflug A, Deinlein T, de Giorgi V, Kittler H, Lallas A, Malvehy J, Moscarella E, Puig S, Scalvenzi M, Thomas L, Zalaudek I, Alfano R, Argenziano G. Seven Non-melanoma Features to Rule Out Facial Melanoma. Acta Derm Venereol. 2017 Nov 15;97(10):1219-1224. doi: 10.2340/00015555-2759. PMID: 28761960.
  • Menzies SW. Dermoscopy of pigmented basal cell carcinoma. Clin Dermatol. 2002 May-Jun;20(3):268-9. doi: 10.1016/s0738-081x(02)00229-8. PMID: 12074864.
  • Watanabe S, Sawada M, Dekio I, Ishizaki S, Fujibayashi M, Tanaka M. Chronology of lichen planus-like keratosis features by dermoscopy: a summary of 17 cases. Dermatol Pract Concept. 2016 Apr 30;6(2):29-35. doi: 10.5826/dpc.0602a06. PMID: 27222769; PMCID: PMC4866624.
  • Bollea-Garlatti LA, Galimberti GN, Galimberti RL. Lentigo Maligna: Keys to Dermoscopic Diagnosis. Actas Dermosifiliogr. 2016 Jul-Aug;107(6):489-97. doi: 10.1016/j.ad.2016.01.001. PMID: 26875792.
  • Micantonio T, Neri L, Longo C, Grassi S, Di Stefani A, Antonini A, Coco V, Fargnoli MC, Argenziano G, Peris K. A new dermoscopic algorithm for the differential diagnosis of facial lentigo maligna and pigmented actinic keratosis. Eur J Dermatol. 2018 Apr 1;28(2):162-168. doi: 10.1684/ejd.2018.3246. PMID: 29620004.