title: Dermoscopic rosettes as a clue for pigmented incipient melanoma.
abstract: The rosette structure is a dermoscopic sign visible under polarized light, characterized by 4 white points arranged as a 4-leaf clover. It has been mainly described in facial sun-damaged skin and actinic keratosis, although it has also been found in squamous and basal cell carcinomas, and in 2 cases of hypomelanotic melanomas. We describe 2 different cases of pigmented incipient melanomas with the presence of multiple rosettes and shiny white structures on dermoscopy. In the reflectance confocal microscope they exhibit a disarranged epidermal architecture with atypical and dendritic cells. Histological examination showed focal hyperkeratosis and a normal corneal layer presented alternatively. To our knowledge this is the first description of rosette structures in pigmented melanomas. Based on a proper dermoscopic- confocal-histopathological correlation, we hypothesize that rosettes could correspond to optic phenomena due to changes in the superficial epidermal reaction and in the acrosyringia.
authors.affiliation: Dermatology Department, Melanoma Unit, Hospital Clínic and Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona University, Barcelona, Spain.
authors.forename: Tatiana
authors.initials: T
authors.lastname: González-Álvarez
authors.forename: Miquel
authors.initials: M
authors.lastname: Armengot-Carbó
authors.forename: Alicia
authors.initials: A
authors.lastname: Barreiro
authors.forename: Ivette
authors.initials: I
authors.lastname: Alarcón
authors.forename: Cristina
authors.initials: C
authors.lastname: Carrera
authors.forename: Adriana
authors.initials: A
authors.lastname: García
authors.forename: Josep
authors.initials: J
authors.lastname: Malvehy
authors.forename: Susana
authors.initials: S
authors.lastname: Puig
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D046169:Dermoscopy; D005260:Female; D006801:Humans; D008545:Melanoma / Q000473:pathology*; D018613:Microscopy, Confocal; D010858:Pigmentation; D012878:Skin Neoplasms / Q000473:pathology*