Practical Dermoscopy
Dermoscopic Features of Extrafacial Lentigo Maligna
Claves dermatoscópicas en lentigo maligno extrafacial
C. Sarró-Fuente
, R. Gamo-Villegas, U. Floristán-Muruzábal
Corresponding author
Servicio de Dermatología del Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
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"apellidos" => "Sarró-Fuente" "email" => array:1 [ 0 => "claudia.sarro@salud.madrid.org" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Gamo-Villegas" ] 2 => array:2 [ "nombre" => "U." "apellidos" => "Floristán-Muruzábal" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología del Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Claves dermatoscópicas en lentigo maligno extrafacial" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 753 "Ancho" => 1005 "Tamanyo" => 85896 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermoscopic image. Note the well-defined eccentric pigmentation (triangle), the characteristic reticular pattern at the periphery (white arrow), the structureless center with complete disruption of the reticular structure and white lines (asterisks), and the erythematous background with atypical vascularization (black arrows).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Examination of a 77-year-old man in the dermatology clinic revealed a 1.5-cm light brown spot with eccentric pigmentation in the right pectoral region (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Diagnosis</span><p id="par0010" class="elsevierStylePara elsevierViewall">Dermoscopic examination showed erased areas containing white lines and atypical vascularization in the center and a characteristic fine reticular pattern at the periphery (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Comment</span><p id="par0015" class="elsevierStylePara elsevierViewall">Examination by confocal microscopy showed an epidermis with abundant dendritic cells and numerous junctional thickenings at the dermoepidermal junction (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). The lesion was excised and histologic examination confirmed a diagnosis of extrafacial lentigo maligna (LM).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Extrafacial LM is a lentiginous form of melanoma associated with chronic sun damage.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Its incidence is increasing in Spain for a number of reasons, including longer life expectancy and improved clinical identification of these lesions and their dermoscopic features.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2–4</span></a> A clinical progression model with dermoscopic features (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>) based on confocal microscopy findings has been proposed for extrafacial LA.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,5</span></a> The first features observed are areas of reticular disruption, followed by erased areas surrounded by pigment dots and triangular structures, which progressively evolve to form angulated and zig-zag lines. More advanced lesions show large erased areas with atypical vascularization and typically contain traces of a fine peripheral reticular pattern pointing to the melanocytic nature of the lesion.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The greatest diagnostic challenges are thus posed by early-stage lesions (when the only finding is reticular disruption) and advanced lesions (when practically all structures have been erased). Identification of advanced lesions is crucial. We recommend paying special attention to atypical vascularization, white lines, and the characteristic traces of the reticular pattern at the periphery.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Funding</span><p id="par0030" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflicts of Interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Diagnosis" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Comment" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Funding" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflicts of Interest" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 869 "Ancho" => 1005 "Tamanyo" => 250236 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical image. Pale brown 1.5-cm spot with eccentric pigmentation.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 753 "Ancho" => 1005 "Tamanyo" => 85896 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermoscopic image. Note the well-defined eccentric pigmentation (triangle), the characteristic reticular pattern at the periphery (white arrow), the structureless center with complete disruption of the reticular structure and white lines (asterisks), and the erythematous background with atypical vascularization (black arrows).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 649 "Ancho" => 1005 "Tamanyo" => 151735 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Confocal microscopy. A, Epidermis containing numerous dendritic cells. B, Junctural thickening and dendritic cells at the dermoepidermal junction.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 308 "Ancho" => 1310 "Tamanyo" => 73267 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Modified dermoscopic extrafacial lentigo maligna progression model adapted from Gamo-Villegas et al.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> A, Reticular disruption. B, Erased area and triangular structures. C, Angulated and zig-zag lines. D, Large areas.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical and dermoscopic characteristics of melanomas on nonfacial chronically sun-damaged skin" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Jaimes" 1 => "A.A. Marghoob" 2 => "H. Rabinovitz" 3 => "R.P. Braun" 4 => "A. Cameron" 5 => "C. 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