title: Flat pigmented macules on sun-damaged skin of the head/neck: junctional nevus, atypical lentiginous nevus, or melanoma in situ?
abstract: The clinical recognition of lentigo maligna (LM) in the mottled chronic sun-damaged skin can be challenging, because it shares many clinical features with other pigmented macules that commonly arise on sun-damaged skin. These include solar lentigo, flat seborrheic keratosis, and pigmented actinic keratosis, but almost never "nevus." The reason nevus is not included in the differential diagnosis of LM can be explained by the fact that the stereotypical appearance of a facial nevus differs remarkably from that of an LM. Facial nevi in adults are usually nodular, dome-shaped, well-defined, and hypopigmented (i.e., intradermal nevus of the Miescher type), whereas LM typically appears as a flat, ill-defined, and pigmented macule. Although this concept based on clinical observations sounds reasonable, clinicians apply it often only unconsciously and accept a given histopathologic diagnosis of a "junctional or lentiginous nevus" of a flat pigmented facial macule without the necessary criticism about its clinicopathologic validity.
authors: Skin Cancer Unit, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, Viale Risorgimento 80, 42100 Reggio Emilia, Italy; Department of Dermatology, Medical University of Graz, Auenbruggerplatz 8, 8036 Graz, Austria. Electronic address: iris.zalaudek@gmail.com.
authors: Iris
authors: I
authors: Zalaudek
authors: Carlo
authors: C
authors: Cota
authors: Gerardo
authors: G
authors: Ferrara
authors: Elvira
authors: E
authors: Moscarella
authors: Pascale
authors: P
authors: Guitera
authors: Caterina
authors: C
authors: Longo
authors: Simonetta
authors: S
authors: Piana
authors: Giuseppe
authors: G
authors: Argenziano
mesh_terms: D003937:Diagnosis, Differential; D005153:Facial Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D018327:Hutchinson's Melanotic Freckle / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D009508:Nevus, Pigmented / Q000473:pathology*; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery; D013472:Sunlight / Q000009:adverse effects*