Pigmented actinic keratosis

Pigmented actinic keratosis simulating a

Lentigo maligna.

F. Peral Rubio, M.D.Department of Dermatology Hospital Universitario Virgen Macarena, Seville, Spain

Pigmented actinic keratosis simulating a Lentigo maligna.

A 56-years-old men. The patient was referred to us

for the assessment of a pigmented lesion on the cheek 7 years previously.

Pigmented actinic keratosis simulating a Lentigo maligna

The dermoscopy revealed: In the upper

-Slate gray and brown dots .

-Annular granular pattern of gray dots.

-Asymmetric pigmented follicular openings In the middle and lower:

- Erythematous pseudonetwork, in which there are prominent hair follicles surrounded by a white halo.

Annular granular pattern of gray dots

Slate gray and brown dots

Asymmetric pigmented follicular openings

Erythematous pseudonetwork

Pigmented actinic keratosis simulating a Lentigo maligna

A biopsy was performed on the pigmented area and pathology revealed a pigmented actinic keratosis.

Pigmented actinic keratosis simulating a Lentigo maligna

Dermoscopy of no pigmented actinic keratosis:Typical feature is a composite pattern

named “strawberry” characterized by:

• A erythematous pseudonetwork on facial skin, in which there are prominent hair follicles surrounded by a white halo.

• If the folllicle has a yellow central plaque they may look like a target.

Pigmented actinic keratosis simulating a Lentigo maligna

Dermoscopy of pigmented actinic keratosis: Facial pigmented actinic keratosis is a differential

diagnosis of lentigo maligna because it can have the same clinical and dermoscopic aspects:

• Gray or brown dots and globules.• Asymmetric pigmented follicles.• Annular-granular structures.• Possible clues for pigmented actinic keratosis

are scales and a superficial broken-up network usually not present in lentigo maligna.

Pigmented actinic keratosis simulating a Lentigo maligna

Conclusions The dermatoscopical picture of pigmented

actinic keratosis in this patient was practically indistinguishable from the early stage of Lentigo Maligna.

Pigmented actinic keratosis has a striking similarity to lentigo maligna in clinical and dermatoscopic features, thus representing a diagnostic challange.

Pigmented actinic keratosis simulating a

Lentigo maligna.

F. Peral Rubio, M.D.Department of Dermatology Hospital Universitario Virgen Macarena, Seville, Spain