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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Presentaci&#243;n del caso problema</span><p id="par0005" class="elsevierStylePara elsevierViewall">Un hombre de 48 a&#241;os&#44; sin antecedentes de inter&#233;s&#44; valorado durante el seguimiento en la consulta de dermatoscopia digital&#44; presentaba en el hombro derecho una m&#225;cula de color marr&#243;n claro&#44; de 1<span class="elsevierStyleHsp" style=""></span>cm de di&#225;metro mayor&#44; sin cambios evidentes durante el seguimiento con mapas corporales con dermatoscopia digital &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Refer&#237;a haber estado recibiendo sesiones de depilaci&#243;n l&#225;ser hasta un a&#241;o y medio antes de la consulta&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Presentaci&#243;n de las dos im&#225;genes acompa&#241;adas de la siguiente frase &#191;Cu&#225;l es su diagn&#243;stico&#63;</span><p id="par0010" class="elsevierStylePara elsevierViewall">El examen con dermatoscopia mostraba &#250;nicamente unas &#225;reas borradas centrales con vascularizaci&#243;n at&#237;pica y un ret&#237;culo fino t&#237;pico en periferia &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46; &#191;Cu&#225;l es su diagn&#243;stico&#63;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Comentario</span><p id="par0015" class="elsevierStylePara elsevierViewall">Se realiz&#243; microscoscopia confocal de la lesi&#243;n que revel&#243; una epidermis con abundantes c&#233;lulas dendr&#237;ticas&#44; as&#237; como una desestructuraci&#243;n de la uni&#243;n dermoepid&#233;rmica donde tambi&#233;n se observaron c&#233;lulas at&#237;picas &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#46; La lesi&#243;n fue extirpada con el diagn&#243;stico histol&#243;gico de lentigo maligno extrafacial &#40;LME&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Los LME son melanomas de patr&#243;n lentiginoso asociados a da&#241;o solar cr&#243;nico cuya incidencia est&#225; aumentando<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#8211;3</span></a>&#46; Se ha descrito un modelo de progresi&#243;n cl&#237;nica y su representaci&#243;n dermatosc&#243;pica de estas lesiones<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2&#44;4</span></a>&#46; Lo primero que ocurre es la disrupci&#243;n del ret&#237;culo&#44; seguido de la aparici&#243;n de unas &#225;reas borradas que presentan alrededor puntos de pigmento y estructuras triangulares&#44; progresando a l&#237;neas anguladas y en &#171;zig-zag&#187;&#8217;&#46; Por &#250;ltimo&#44; la evoluci&#243;n es al borramiento casi completo de la lesi&#243;n&#44; presentando &#250;nicamente una vascularizaci&#243;n at&#237;pica central y unas l&#237;neas blancas cortas<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2&#44;4</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">La mayor dificultad en el diagn&#243;stico ocurre en las lesiones incipientes&#44; que conservan muchas zonas de patr&#243;n reticular t&#237;pico y una m&#237;nima distorsi&#243;n del ret&#237;culo&#44; y en los casos m&#225;s evolucionados&#44; en los que se observa una p&#233;rdida casi completa del ret&#237;culo&#44; con la persistencia de unas &#225;reas de patr&#243;n reticular en la periferia&#46; En 2022 describimos un caso de LME muy similar al actual&#44; que presentaba por dermatoscopia casi toda la lesi&#243;n borrada con unas l&#237;neas blancas cortas y vascularizaci&#243;n at&#237;pica y un ret&#237;culo preservado en la periferia<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a>&#46; El lentigo maligno de la <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a> no presentaba l&#237;neas blancas centrales sino solo una vascularizaci&#243;n at&#237;pica y un ret&#237;culo perif&#233;rico que pon&#237;a en evidencia el origen melanoc&#237;tico de la lesi&#243;n&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">La detecci&#243;n precoz del lentigo maligno es muy importante para evitar la progresi&#243;n del mismo a melanoma invasivo<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a>&#46; Existen casos muy poco expresivos&#44; por lo que recomendamos prestar especial atenci&#243;n a las lesiones que tengan restos de ret&#237;culo pigmentado con una vascularizaci&#243;n at&#237;pica central&#44; tengan o no l&#237;neas blancas cortas en su interior&#46;</p></span></span>"
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