Reflectance confocal findings in a large-cell acanthoma with histologic correlation

Alli J Blumstein,Katharine L Hanlon,Wei-Shen Chen,George Elgart,James M Grichnik,Lilia Correa-Selm

doi:10.1016/j.jdcr.2021.08.016

Abstract

The patient, a 91-year-old woman with no history of skin cancer, presented with an 8-mm flat, irregularly pigmented macule on the forehead for 2 years (Fig 1, A). The lesion had been asymptomatic, and the patient was not aware of the changes in its appearance. Contact nonpolarized dermoscopy showed an irregularly shaped lesion with homogeneous pigmentation and focal darker pigmentation. Occasional circles within circles and perifollicular pigmentation were noted (Fig 1, B).

Highlights

CLINICAL PRESENTATION The patient, a 91-year-old woman with no history of skin cancer, presented with an 8-mm flat, irregularly pigmented macule on the forehead for 2 years (Fig 1, A)
Given the presence of sheets of dendritic cells under reflectance confocal microscope (RCM), a shave biopsy was performed and submitted for histologic examination to rule out melanoma in situ
RCM has proved its clinical utility as a noninvasive tool to aid in the diagnosis of benign and malignant skin lesions in real time.[1]

Summary

CONFOCAL MICROSCOPY

Reflectance confocal findings in a large-cell acanthoma with histologic correlation. BFA,b,c Wei-Shen Chen, MD,c George Elgart, MD,d James M. CLINICAL PRESENTATION The patient, a 91-year-old woman with no history of skin cancer, presented with an 8-mm flat, irregularly pigmented macule on the forehead for 2 years (Fig 1, A). The lesion had been asymptomatic, and the patient was not aware of the changes in its appearance. Contact nonpolarized dermoscopy showed an irregularly shaped lesion with homogeneous pigmentation and focal darker pigmentation. Occasional circles within circles and perifollicular pigmentation were noted (Fig 1, B)

CONFOCAL MICROSCOPY APPEARANCE The lesion was examined using the VivaScope

DISCUSSION