Lentigo Maligna — SCE Dermatology MCQ

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HardSkin CancerLentigo MalignaSCE Dermatology

A 35-year-old woman presents with a large irregular pigmented macule on her left cheek that has been present for several years and is slowly enlarging. Dermoscopy shows asymmetric perifollicular pigmentation, annular-granular structures (grey dots around follicles), and rhomboid structures. What is the most likely diagnosis?

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Correct answer: C — Lentigo maligna

The dermoscopic features described are characteristic of lentigo maligna (melanoma in situ of the lentigo maligna type). Specific features include asymmetric perifollicular pigmentation (pigment asymmetrically distributed around follicular openings), annular-granular structures (grey dots/globules in a ring around follicles), and rhomboidal structures (pigmented zig-zag lines between follicular openings). These features reflect the pattern of melanocyte proliferation along the dermal-epidermal junction of sun-damaged facial skin. Excision with 5-10 mm margins aiming for histological clearance is recommended. Staged excision techniques may be needed for facial lesions.

Reference: BAD 2017 Melanoma Guidelines; BAD Dermoscopy Guidelines