We have come to appreciate that the rosette structure, depicted as 4 white points arranged as a 4-leaf clover or as leaves radiating out from a central stem, may be seen under polarized dermoscopy in a range of skin lesions.1 Until recently, rosettes were deemed to be a dermoscopic structure observed only in actinic keratoses (AKs) and squamous cell carcinoma (SCCs), and their presence was thought to support this diagnosis.1 We assert, instead, that rosettes are not uniquely specific to SCCs (Figure, A, arrows) or AKs. Rather, rosettes can be seen in a variety of neoplasms, including, but not limited to, basal cell carcinomas (Figure, B, arrows) and melanomas (Figure, C, arrows, and Figure, D, arrow). They have also been observed in nonlesional actinically damaged skin.
Liebman TN, Scope A, Rabinovitz H, Braun RP, Marghoob AA. Rosettes May Be Observed in a Range of Conditions. Arch Dermatol. 2011;147(12):1468. doi:10.1001/archdermatol.2011.312