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. 2017 Aug 9;153(8):771–780. doi: 10.1001/jamadermatol.2017.1323

Figure 1. Lentigo Maligna in a Man in His 60s.

Figure 1.

A, A 25-mm brown macule on the nose (inset). Dermoscopy of the central area showed a pseudonetwork, brown rhomboidal structures, focal annular-granular pattern, focal asymmetric pigmented follicular openings, increased density of vascular network with red rhomboidal structures and targetlike patterns. A scar from a previous, nonconfirmatory biopsy is visible. B, Reflectance confocal microscopy (RCM) mosaic (1 × 1 mm) at the epidermal layer showing epidermal disarray with atypical pagetoid cells. C, Detail of an atypical pagetoid cell. D, RCM image (0.5 × 0.5 mm). Dendritic pagetoid cells and round, large pagetoid cells are observed in suprabasal layers. E, RCM image (0.5 × 0.5 mm). Abundant dendritic cells and dendritic processes near the follicular openings. F, Biopsy specimen revealed an atypical proliferation of melanocytes in an atrophic epidermis with extension along follicular structures. Elastosis in the upper dermis. Hematoxylin-eosin (H&E), original magnification ×200. Inset: atypical intraepidermal melanocytes in more detail (H&E, original magnification ×400). G, Melan-A staining, original magnification ×100, labeling the atypical proliferation of melanocytes (cytoplasm) in the epidermis and adnexa. Isolated pagetoid melanocytes are observed. H, Microphthalmia-associated transcription factor (MITF) staining, original magnification ×100, labeling the nucleus of melanocytes. I, SRY-related HMG (high mobility group)-box gene 10 (SOX10) staining, original magnification ×100, with the same features as MITF.