Diagnostic Considerations

Consider melanoma and lentigo maligna melanoma. Also consider porokeratosis.^[30]

Ephelides (ie, freckles) are light brown macules that occur on the sun-exposed areas of the face, dorsum of the hands, and forearms. These lesions are more common in individuals with light hair, especially red hair, and light skin, but they can also occur in people with dark hair and skin. They usually appear in the summer months, and they may persist throughout life. Examination of the skin with a Wood lamp may reveal ephelides that are not evident in ordinary light. The distribution is symmetric, and the lesions may be either sparse or dense. The color of the lesions tends to deepen after sun exposure, ranging from pale yellow to brown or even black. The borders are well defined and irregular, and the lesions can have a diameter as large as 5 mm. In people with natural ephelides, a single UVB exposure can induce the formation of additional ephelides.

Diagnostic key points for lentigo are noteworthy to distinguish it from lentigo maligna, the former having findings that include annular-granular structures and a gray pseudonetwork.^[31]However, pigmented actinic keratosis, lichen planus–like keratosis, and lentigo maligna may be challenging to clinically distinguish, making the differential diagnosis difficult.^[32] The distinction between lentigo maligna and solar lentigo may be challenging. Digital epiluminescence microscopy–specific criteria may facilitate distinction.^[33] Spontaneous hair repigmentation of physiologically white or gray hair is rare occurrence and may portend lentigo maligna in elderly individuals.^[34]

Large cell acanthoma may be a variant of solar lentigo.^[35]

Differential Diagnoses

Workup

Derancourt C, Bourdon-Lanoy E, Grob JJ, Guillaume JC, Bernard P, Bastuji-Garin S. Multiple large solar lentigos on the upper back as clinical markers of past severe sunburn: a case-control study. Dermatology. 2007. 214(1):25-31. [QxMD MEDLINE Link].
Byrom L, Barksdale S, Weedon D, Muir J. Unstable solar lentigo: A defined separate entity. Australas J Dermatol. 2016 Feb 2. [QxMD MEDLINE Link].
Zaballos P, Rodero J, Pastor L, Vives JM, Puig S, Malvehy J. Dermoscopy of lichenoid regressing solar lentigines. Arch Dermatol. 2008 Feb. 144(2):284. [QxMD MEDLINE Link].
Olds H, Utz S, Abrams J, Terrano D, Mehregan D. Use of PRAME immunostaining to distinguish early melanoma in situ from benign pigmented conditions. J Cutan Pathol. 2022 Jun. 49 (6):510-514. [QxMD MEDLINE Link].
Goorochurn R, Viennet C, Tissot M, Locatelli F, Granger C, Varin-Blank N, et al. Differential morphological and functional features of fibroblasts explanted from Solar Lentigo. Br J Dermatol. 2017 Feb 17. [QxMD MEDLINE Link].
Aoki H, Moro O, Tagami H, Kishimoto J. Gene expression profiling analysis of solar lentigo in relation to immunohistochemical characteristics. Br J Dermatol. 2007 Jun. 156(6):1214-23. [QxMD MEDLINE Link].
Hafner C, Stoehr R, van Oers JM, et al. FGFR3 and PIK3CA mutations are involved in the molecular pathogenesis of solar lentigo. Br J Dermatol. 2009 Mar. 160(3):546-51. [QxMD MEDLINE Link].
Vierkötter A, Krämer U, Sugiri D, Morita A, Yamamoto A, Kaneko N, et al. Development of lentigines in German and Japanese women correlates with variants in the SLC45A2 gene. J Invest Dermatol. 2012 Mar. 132(3 Pt 1):733-6. [QxMD MEDLINE Link].
Samuelov L, Sarig O, Gat A, Halachmi S, Shalev S, Sprecher E. Extensive lentigo simplex, linear epidermolytic naevus and epidermolytic naevus comedonicus caused by a somatic mutation in KRT10. Br J Dermatol. 2014 Dec 15. [QxMD MEDLINE Link].
Hansen LK, Risby K, Bygum A, Gerdes AM. [LEOPARD syndrome]. Ugeskr Laeger. 2009 Jan 19. 171(4):247. [QxMD MEDLINE Link].
Hickey JR, Robson A, Barker JN, Smith CH. Does topical tacrolimus induce lentigines in children with atopic dermatitis? A report of three cases. Br J Dermatol. 2005 Jan. 152(1):152-4. [QxMD MEDLINE Link].
Basarab T, Millard TP, McGregor JM, Barker JN. Atypical pigmented lesions following extensive PUVA therapy. Clin Exp Dermatol. 2000 Mar. 25(2):135-7. [QxMD MEDLINE Link].
Miller RA. Psoralens and UV-A-induced stellate hyperpigmented freckling. Arch Dermatol. 1982 Aug. 118(8):619-20. [QxMD MEDLINE Link].
Rhodes AR, Harrist TJ, Momtaz-T K. The PUVA-induced pigmented macule: a lentiginous proliferation of large, sometimes cytologically atypical, melanocytes. J Am Acad Dermatol. 1983 Jul. 9(1):47-58. [QxMD MEDLINE Link].
Peter RU, Gottlober P, Nadeshina N, Krahn G, Plewig G, Kind P. Radiation lentigo. A distinct cutaneous lesion after accidental radiation exposure. Arch Dermatol. 1997 Feb. 133(2):209-11. [QxMD MEDLINE Link].
LaRosa CL, Foulke GT, Feigenbaum DF, Cordoro KM, Zaenglein AL. Lentigines in resolving psoriatic plaques: rarely reported sequelae in pediatric cases. Pediatr Dermatol. 2015 May. 32 (3):e114-7. [QxMD MEDLINE Link].
Alper JC, Holmes LB. The incidence and significance of birthmarks in a cohort of 4,641 newborns. Pediatr Dermatol. 1983 Jul. 1(1):58-68. [QxMD MEDLINE Link].
Kavak A, Parlak AH, Yesildal N, Aydogan I, Anul H. Preliminary study among truck drivers in Turkey: effects of ultraviolet light on some skin entities. J Dermatol. 2008 Mar. 35(3):146-50. [QxMD MEDLINE Link].
O'Neill JF, James WD. Inherited patterned lentiginosis in blacks. Arch Dermatol. 1989 Sep. 125(9):1231-5. [QxMD MEDLINE Link].
Bolognia JL. Reticulated black solar lentigo ('ink spot' lentigo). Arch Dermatol. 1992 Jul. 128(7):934-40. [QxMD MEDLINE Link].
Campbell T, Felsten L, Moore J. Disappearance of lentigines in a patient receiving imatinib treatment for familial gastrointestinal stromal tumor syndrome. Arch Dermatol. 2009 Nov. 145(11):1313-6. [QxMD MEDLINE Link].
Pollefliet C, Corstjens H, González S, Hellemans L, Declercq L, Yarosh D. Morphological characterization of solar lentigines by in vivo reflectance confocal microscopy: a longitudinal approach. Int J Cosmet Sci. 2013 Apr. 35(2):149-55. [QxMD MEDLINE Link].
Shahriari N, Grant-Kels JM, Rabinovitz H, Oliviero M, Scope A. Reflectance confocal microscopy: Diagnostic criteria of common benign and malignant neoplasms, dermoscopic and histopathologic correlates of key confocal criteria, and diagnostic algorithms. J Am Acad Dermatol. 2021 Jan. 84 (1):17-31. [QxMD MEDLINE Link].
Roth DE, Hodge SJ, Callen JP. Possible ultraviolet A-induced lentigines: a side effect of chronic tanning salon usage. J Am Acad Dermatol. 1989 May. 20(5 Pt 2):950-4. [QxMD MEDLINE Link].
Salisbury JR, Williams H, du Vivier AW. Tanning-bed lentigines: ultrastructural and histopathologic features. J Am Acad Dermatol. 1989 Oct. 21(4 Pt 1):689-93. [QxMD MEDLINE Link].
Williams HC, Salisbury J, Brett J, du Vivier A. Sunbed lentigines. Br Med J (Clin Res Ed). 1988 Apr 16. 296(6629):1097. [QxMD MEDLINE Link]. [Full Text].
Lin IS, Wang JN, Chao SC, Wu JM, Lin SJ. PTPN11 mutations in LEOPARD syndrome: report of four cases in Taiwan. J Formos Med Assoc. 2009 Oct. 108(10):803-7. [QxMD MEDLINE Link].
Horvath A, Stratakis CA. Carney complex and lentiginosis. Pigment Cell Melanoma Res. 2009 Oct. 22(5):580-7. [QxMD MEDLINE Link].
Vaidya DC, Schwartz RA, Janniger CK. Nevus spilus. Cutis. 2007 Dec. 80(6):465-8. [QxMD MEDLINE Link].
Foster C, Tallon B. Porokeratosis: a differential diagnosis to consider in benign lichenoid keratosis. Int J Clin Exp Pathol. 2022. 15 (2):56-62. [QxMD MEDLINE Link]. [Full Text].
Tanaka M, Sawada M, Kobayashi K. Key points in dermoscopic differentiation between lentigo maligna and solar lentigo. J Dermatol. 2011 Jan. 38(1):53-8. [QxMD MEDLINE Link].
Lallas A, Argenziano G, Moscarella E, Longo C, Simonetti V, Zalaudek I. Diagnosis and management of facial pigmented macules. Clin Dermatol. 2014 Jan-Feb. 32(1):94-100. [QxMD MEDLINE Link].
Annessi G, Bono R, Abeni D. Correlation between digital epiluminescence microscopy parameters and histopathological changes in lentigo maligna and solar lentigo: A dermoscopic index for the diagnosis of lentigo maligna. J Am Acad Dermatol. 2017 Feb. 76 (2):234-243. [QxMD MEDLINE Link].
Chan C, Magro CM, Pham AK, LeBlanc RE, Yan S, Barton DT, et al. Spontaneous Hair Repigmentation in an 80-Year-Old Man: A Case of Melanoma-Associated Hair Repigmentation and Review of the Literature. Am J Dermatopathol. 2019 Jan 29. [QxMD MEDLINE Link].
Fraga GR, Amin SM. Large cell acanthoma: a variant of solar lentigo with cellular hypertrophy. J Cutan Pathol. 2014 Sep. 41(9):733-9. [QxMD MEDLINE Link].
Shin J, Park JY, Kim SJ, Kang HY. Characteristics of keratinocytes in facial solar lentigo with flattened rete ridges: comparison with melasma. Clin Exp Dermatol. 2015 Feb 22. [QxMD MEDLINE Link].
Unver N, Freyschmidt-Paul P, Horster S, et al. Alterations in the epidermal-dermal melanin axis and factor XIIIa melanophages in senile lentigo and ageing skin. Br J Dermatol. 2006 Jul. 155(1):119-28. [QxMD MEDLINE Link].
Raziee M, Balighi K, Shabanzadeh-Dehkordi H, Robati RM. Efficacy and safety of cryotherapy vs. trichloroacetic acid in the treatment of solar lentigo. J Eur Acad Dermatol Venereol. 2008 Mar. 22(3):316-9. [QxMD MEDLINE Link].
Hexsel D, Hexsel C, Porto MD, Siega C. Triple combination as adjuvant to cryotherapy in the treatment of solar lentigines: investigator-blinded, randomized clinical trial. J Eur Acad Dermatol Venereol. 2014 Mar 31. [QxMD MEDLINE Link].
Pierard-Franchimont C, Henry F, Quatresooz P, Vroome V, Pierard GE. Analytic quantification of the bleaching effect of a 4-hydroxyanisole-tretinoin combination on actinic lentigines. J Drugs Dermatol. 2008 Sep. 7(9):873-8. [QxMD MEDLINE Link].
Gillbro JM, Olsson MJ. The melanogenesis and mechanisms of skin-lightening agents - existing and new approaches. Int J Cosmet Sci. 2011 Jun. 33(3):210-21. [QxMD MEDLINE Link].
Yamada T, Hasegawa S, Inoue Y, Kunita M, Ohsumi K, Sakaida T, et al. Inhibitory effect of Phalaenopsis orchid extract on WNT1-induced immature melanocyte precursor differentiation in a novel in vitro solar lentigo model. Biosci Biotechnol Biochem. 2016 Mar 4. 1-6. [QxMD MEDLINE Link].
Kim SH, Paik BR, Lee SH, Lee SM, Kim MJ, Kim EJ, et al. Clinical brightening efficacy and safety of Melasolv™ (3,4,5-trimethoxy cinnamate thymol ester, TCTE) in Southeast Asian women. J Cosmet Dermatol. 2021 Feb 2. [QxMD MEDLINE Link].
Ishikawa Y, Niwano T, Hirano S, Numano K, Takasima K, Imokawa G. Whitening effect of L-ascorbate-2-phosphate trisodium salt on solar lentigos. Arch Dermatol Res. 2019 Apr. 311 (3):183-191. [QxMD MEDLINE Link].
Cantisani C, Cantoresi F, Mercuri SR, Binic I, Golubovic M, Marino R, et al. Efficacy of imiquimod 3.75% cream for the treatment of solar lentigo. Dermatol Ther. 2020 Feb 7. e13256. [QxMD MEDLINE Link].
Sezer E, Erbil H, Kurumlu Z, Tastan HB, Etikan I. A comparative study of focal medium-depth chemical peel versus cryosurgery for the treatment of solar lentigo. Eur J Dermatol. 2007 Jan-Feb. 17(1):26-9. [QxMD MEDLINE Link].
Leroy D, Dompmartin A, Dubreuil A, Louvet S. Cryotherapy of PUVA lentigines. Br J Dermatol. 1996 Dec. 135(6):988-90. [QxMD MEDLINE Link].
Ortonne JP, Pandya AG, Lui H, Hexsel D. Treatment of solar lentigines. J Am Acad Dermatol. 2006 May. 54(5 Suppl 2):S262-71. [QxMD MEDLINE Link].
Bukvic Mokos Z, Lipozencic J, Pasic A, Fattorini I. Laser therapy for solar lentigines: review of the literature and case report. Acta Dermatovenerol Croat. 2006. 14(2):81-5. [QxMD MEDLINE Link].
Todd MM, Rallis TM, Gerwels JW, Hata TR. A comparison of 3 lasers and liquid nitrogen in the treatment of solar lentigines: a randomized, controlled, comparative trial. Arch Dermatol. 2000 Jul. 136(7):841-6. [QxMD MEDLINE Link].
Chan HH, Fung WK, Ying SY, Kono T. An in vivo trial comparing the use of different types of 532 nm Nd:YAG lasers in the treatment of facial lentigines in Oriental patients. Dermatol Surg. 2000 Aug. 26(8):743-9. [QxMD MEDLINE Link].
Lee Y, Choi EH, Lee SW. Low-fluence Q-switched 1,064-nm neodymium-doped yttrium aluminum garnet laser for the treatment of facial partial unilateral lentiginosis in Koreans. Dermatol Surg. 2012 Jan. 38(1):31-7. [QxMD MEDLINE Link].
Vachiramon V, Panmanee W, Techapichetvanich T, Chanprapaph K. Comparison of Q-switched Nd: YAG laser and fractional carbon dioxide laser for the treatment of solar lentigines in Asians. Lasers Surg Med. 2016 Apr. 48 (4):354-9. [QxMD MEDLINE Link].
Nam JH, Kim HS, Lee GY, Kim WS. Beneficial Effect of Low Fluence 1,064 nm Q-Switched Neodymium:Yttrium-Aluminum-Garnet Laser in the Treatment of Senile Lentigo. Ann Dermatol. 2017 Aug. 29 (4):427-432. [QxMD MEDLINE Link].
Campolmi P, Bonan P, Cannarozzo G, et al. Intense pulsed light in the treatment of non-aesthetic facial and neck vascular lesions: report of 85 cases. J Eur Acad Dermatol Venereol. 2011 Jan. 25(1):68-73. [QxMD MEDLINE Link].
Kauvar ANB, Sun R, Bhawan J, Singh G, Ugonabo N, et al. Treatment of facial and non-facial lentigines with a 730 nm picosecond titanium: Sapphire laser is safe and effective. Lasers Surg Med. 2022 Jan. 54 (1):89-97. [QxMD MEDLINE Link].
Josse G, Le Digabel J, Questel E. Protection against summer solar lentigo over-pigmentation with a SPF30 daily cream. Skin Res Technol. 2018 Feb 15. [QxMD MEDLINE Link].

Media Gallery

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.

of 4

Author

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Professor of Pediatrics, Professor of Medicine, Rutgers New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, New York Academy of Medicine, Royal College of Physicians of Edinburgh, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Coauthor(s)

Jason F Okulicz, MD, FACP, FIDSA Director, HIV Medical Evaluation Unit, Infectious Disease Service, San Antonio Military Medical Center; Associate Professor of Medicine, F Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences; Clinical Associate Professor of Medicine, University of Texas Health Science Center at San Antonio; Adjunct Clinical Instructor, Feik School of Pharmacy, University of the Incarnate Word

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

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Gilead Sciences.

Sergiusz Jozwiak, MD, PhD Professor and Head of Pediatric Neurology, Medical University of Warsaw, Poland

Sergiusz Jozwiak, MD, PhD is a member of the following medical societies: Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Dermatologic/Mohs Surgeon, The Surgery Center at Plano Dermatology

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

Disclosure: Nothing to disclose.

John G Albertini, MD Private Practice, The Skin Surgery Center; Clinical Associate Professor (Volunteer), Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine; Past President, American College of Mohs Surgery

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

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: QualDerm Partners; Novascan<br/>Have a 5% or greater equity interest in: QualDerm Partners - North Carolina.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

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

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

Additional Contributors

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: Canadian Medical Association, Ontario Medical Association, Royal College of Physicians and Surgeons of Canada, Canadian Dermatology Association, American Academy of Dermatology, American Society for Clinical Pharmacology and Therapeutics

Disclosure: Nothing to disclose.

Lentigo Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

References

Tables

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