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September 2018

Reflectance Confocal Microscopic and En Face Histopathologic Correlation of the Dermoscopic “Circle Within a Circle” in Lentigo Maligna

Author Affiliations
  • 1Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
  • 2Department of Dermatology, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
  • 3Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
JAMA Dermatol. 2018;154(9):1092-1094. doi:10.1001/jamadermatol.2018.2216

Differentiating solar lentigo from early lentigo maligna (LM) can be clinically challenging. However, dermoscopy can aid in identifying LM, with a reported sensitivity of 89% and a specificity of 96%.1 Dermoscopic criteria associated with LM include pigmentation in and around hair follicles (circles and circles within circles), perifollicular gray dots and globules (annular-granular pattern), angulated lines creating rhomboidal structures, and pigmented blotches (homogeneous areas, obliteration of hair follicles).1,2 While the histopathologic correlations have been deciphered for some of these structures,3,4 the histopathologic correlation of circle within a circle has remained elusive. The aim of this report is to describe a potential reflectance confocal microscopic (RCM) and en face histopathologic correlation of circle within a circle, which has a low sensitivity (4.2%-5.0%) but high specificity (98.1%) for the diagnosis of LM.2,5