The distinction between a large pigmented actinic keratosis and lentigo maligna is important because their prognosis and management differ. Lentigo maligna is potentially lethal and may be treated by total excision. Actinic keratosis can be treated less aggressively, often with cryotherapy. Clinically, both lesions are tan to brown maculae on sun-exposed skin; the diagnoses must be established histologically. We describe a large pigmented actinic keratosis of the eyelid that was histologically mistaken for a lentigo maligna on a small incisional biospy specimen.
Report of a Case.
A 63-year-old man was referred by a dermatologist to an ophthalmologist for excision of a lentigo maligna of the right lower eyelid. The diagnosis was based on a 2-mm biopsy specimen. The tan macula was triangle-shaped with horizontal and vertical lengths of 11 mm and 9 mm, respectively (Figure 1). The conjunctiva was not involved; there was no regional adenopathy. The lesion was excised,
Salama SD, Margo CE. Large Pigmented Actinic Keratosis of the Eyelid. Arch Ophthalmol. 1995;113(8):977-978. doi:10.1001/archopht.1995.01100080027015