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Case Report/Case Series |

A Digital Dermoscopy Follow-up Illustration and a Histopathologic Correlation for Angulated Lines in Extrafacial Lentigo Maligna

Alexia Vanden Daelen, MD1; Ingrid Ferreira, MD2; Liliane Marot, MD1,2; Isabelle Tromme, PhD1
[+] Author Affiliations
1Department of Dermatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
2Department of Pathology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
JAMA Dermatol. 2016;152(2):200-203. doi:10.1001/jamadermatol.2015.4132.
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ABSTRACT

Importance  The diagnosis of extrafacial lentigo maligna can be a challenge because the dermoscopic features are not well described. These features can share some of the criteria of superficial spreading melanoma and some of facial lentigo maligna; however, these features are often absent. A new dermoscopic pattern has recently been described as forming angulated lines.

Observations  We report 4 cases of extrafacial lentiginous lesions in 3 patients in whom straight angulated lines have been observed as the only key for diagnosis. This is the first time, to our knowledge, that these lines were seen in the follow-up by digital dermoscopy during a lapse time of a few months. This morphologic change led to the excision of the lesion. The pathologic diagnosis of lentigo maligna was established in each case. Moreover, a histologic correlation of these straight angulated lines is documented.

Conclusions and Relevance  Angulated lines could be considered as a new warning sign during the follow-up of extrafacial lentigo. More studies are required to establish the sensitivity and specificity of this newly described dermoscopic feature.

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Figures

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Figure 1.
Lentigo Maligna (LM) of the Back and Left Lower Leg in Patient 1

A, LM of the back. B, LM of the back: evolution after 10 months. C, LM of the left lower leg. D, LM of the left lower leg: evolution after 5 months. In both cases, straight angulated lines are discrete on the initial pictures. Additional lines then appear and grow darker and more easily seen after several months of follow-up. Pictures were taken with a FotoFinder dermoscope (Teachscreen Software GmbH).

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Figure 2.
Lentigo Maligna of the Right Lower Leg in Patient 1

A, A distance of 1 mm between the 2 lines was found dermoscopically and histologically. B, A proliferation of isolated atypical melanocytes focally clustered in 2 nests is observed at the dermoepidermal junction and is associated with an underlying accumulation of melanophages in the superficial dermis directly underneath those nests (hematoxylin-eosin, original magnification ×10).

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Figure 3.
Lentigo Maligna (LM) of the Back in Patient 2

A, LM of the back. B, LM of the back: straight angulated lines are seen appearing after 3 months of evolution. Pictures were taken with a FotoFinder dermoscope (Teachscreen Software GmbH).

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Figure 4.
Lentigo Maligna (LM) of the Leg in Patient 3

A, LM of the leg. B, LM of the leg: evolution after 12 months; straight angulated lines are becoming darker and more visible. Pictures were taken with a FotoFinder dermoscope (Teachscreen Software GmbH).

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