ABSTRACT
The differential diagnosis of a pigmented facial macule is one of the most challenging scenarios for clinicians. Data from epidemiology and evolution of nevi throughout the lifetime must be encountered during the diagnostic approach of melanocytic lesions. Lentigo maligna is associated with chronic, cumulative ultraviolet radiation, is usually found in the elderly, and clinically mimics solar lentigo and pigmented actinic keratosis that are flat and often pigmented. Discrimination of lentigo maligna from the latter entities is challenging on both clinical and dermatoscopic grounds. The initial dermatoscopic manifestations emerge around the follicular openings and progress with the evolution of the tumor. Numerous studies intended to detect dermatoscopic criteria for enhancing early detection of lentigo maligna. A useful clue remains the presence of wide and evident follicular openings that are spared from pigmentation in pigmented actinic keratoses versus the fuzzy follicles seen in lentigo maligna.
