Lentigo Workup

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: William D James, MD   more...
 
Updated: May 31, 2011
 

Other Tests

Dermoscopic evaluation of a few lichenoid regressing solar lentigines showed a pattern similar to that of lichenoid regressing seborrheic keratosis.[22]

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Histologic Findings

Lentigo simplex is characterized by a slight-to-moderate elongation of the rete ridges with melanocyte proliferation in the basal layer, increased melanin in both the melanocytes and the basal keratinocytes, and the presence of melanophages in the upper dermis. Lentigines profusa and agminated lentigo are similar in appearance.

Solar lentigines have elongated rete ridges and a proliferation of pigmented basaloid cells, which form buds and strands. Ink-spot lentigines are also similar to solar lentigines, except the rete ridges in ink-spot lentigines appear less blunted and more tortuous. No atypia of the melanocytes is present. The solar lentigo has an increased number of melanophages compared with unaffected skin from the same subject.[23] These melanophages were demonstrated to be factor XIIIa-positive dermal dendrocytes.

The melanocytes of PUVA lentigines are increased in number and hypertrophic; they frequently demonstrate cellular atypia. Elongation of the rete ridges and increased pigmentation in the basal cell region is present with transepidermal pigment cell excretion.

Radiation lentigines show increased melanin deposition in basal keratinocytes, cellular or nuclear atypia, increased number of melanocytes, and reduction of rete ridges.

Oral and labial melanotic macules show epithelial hyperplasia with somewhat irregular widening and elongation of the rete ridges. Melanin is increased in the melanocytes and keratinocytes of the basal layer and in the melanophages in the dermal papillae; this increase in melanin indicates pigment incontinence. Vulvar and penile lentigines have similar histologic features except for a slight increase in dendritic melanocytes along the basal layer of the epidermis.

Tanning-bed lentigines resemble PUVA lentigines with the increased density of melanocytes, some of which show mild nuclear atypia. Ultrastructurally, these lesions are similar to those of other forms of lentigo.

Ephelides have an increase in pigment content in the basal cell layer, with neither elongated rete ridges nor increased number of melanocytes.

The myxoma syndromes (ie, LAMB, NAME, and Carney syndromes) show basal layer and, sometimes, spinous layer hyperpigmentation with or without elongation of the rete ridges and melanocytic hyperplasia. Melanocytes may have large dendritic processes, and melanophages may be observed in the upper dermis.

In Peutz-Jeghers syndrome, the lentigines also show marked hyperpigmentation of the basal layer. LEOPARD syndrome involves increased pigment content of the epidermis with an increased number of melanocytes. The melanocytes are filled with melanosomes and are distributed singly or in the form of micronests.

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Contributor Information and Disclosures
Author

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

Jason F Okulicz, MD  Assistant Professor of Medicine, Uniformed Services University of the Health Sciences; Staff, Infectious Disease Service, Brooke Army Medical Center

Jason F Okulicz, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Sergiusz Jozwiak, MD  PhD, Head, Professor, Department of Child Neurology, The Children's Memorial Health Institute of Warsaw, Poland

Sergiusz Jozwiak, MD is a member of the following medical societies: Sigma Xi

Disclosure: Novartis Honoraria Speaking and teaching

Specialty Editor Board

Neil Shear, MD  Professor and Chief of Dermatology, Professor of Medicine, Pediatrics and Pharmacology, University of Toronto Faculty of Medicine; Head of Dermatology, Sunnybrook Women's College Health Sciences Center and Women's College Hospital, Canada

Neil Shear, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Clinical Pharmacology and Therapeutics, Canadian Dermatology Association, Canadian Medical Association, Ontario Medical Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

John G Albertini, MD  Consulting Staff, Dermatologic Surgery, The Skin Surgery Center; Program Director, ACGME Accredited Fellowship in Procedural Dermatology

John G Albertini, MD is a member of the following medical societies: American Academy of Dermatology and American College of Mohs Micrographic Surgery and Cutaneous Oncology

Disclosure: Nothing to disclose.

Glen H Crawford, MD  Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital

Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD  Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

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Thirteen-year-old Greek adolescent with xeroderma pigmentosum.
Ephelides (ie, freckles) on the forearm of a 26-year-old redheaded patient.
Woman with solar lentigo.
Close-up view of a woman with solar lentigo.
 
 
 
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