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SummaryBackground Dermoscopy is limited in differentiating accurately between pigmented lentigo maligna (LM) and pigmented actinic keratosis (PAK). This might be related to the fact that most studies have focused on pigmented criteria only, without considering additional recognizable features. Objectives To investigate the diagnostic accuracy of established dermoscopic criteria for pigmented LM and PAK, but including in the evaluation features previously associated with nonpigmented facial actinic keratosis. Methods Retrospectively enrolled cases of histopathologically diagnosed LM, PAK and solar lentigo/early seborrhoeic keratosis (SL/SK) were dermoscopically evaluated for the presence of predefined criteria. Univariate and multivariate regression analyses were performed and receiver operating characteristic curves were used. Results The study sample consisted of 70 LMs, 56 PAKs and 18 SL/SKs. In a multivariate analysis, the most potent predictors of LM were grey rhomboids (sixfold increased probability of LM), nonevident follicles (fourfold) and intense pigmentation (twofold). In contrast, white circles, scales and red colour were significantly correlated with PAK, posing a 14-fold, eightfold and fourfold probability for PAK, respectively. The absence of evident follicles also represented a frequent LM criterion, characterizing 71% of LMs. Conclusions White and evident follicles, scales and red colour represent significant diagnostic clues for PAK. Conversely, intense pigmentation and grey rhomboidal lines appear highly suggestive of LM.

Background Several common inflammatory dermatoses, such as rosacea, seborrheic dermatitis (SD), discoid lupus erythematosus (DLE) and granulomatous skin diseases manifest as erythematous macules or plaques on the facial skin. Although clinical examination represents the cornerstone of diagnosis, the broad variety of clinical features and uncommon presentations of these diseases may cause at times diagnostic and therapeutic uncertainty. Dermoscopy, in addition to its well-documented value in evaluation of skin tumours, is continuously gaining appreciation also in the field of general dermatology. Objective To describe and compare the dermoscopic patterns of common facial inflammatory skin diseases including SD, erythematotelangiectatic rosacea (ER), sarcoidosis, lupus vulgaris (LV), DLE and granuloma faciale (GF). Methods Dermoscopic images of lesions from patients with histopathologically confirmed diagnosis of SD, ER, sarcoidosis, LV, DLE or GF were retrospectively evaluated for the presence of several criteria. Selection of the dermoscopic variables included in the evaluation process was based on the data available in the literature and on our preliminary observations. Results One hundred and fifteen dermoscopic images were included in the study. SD was dermoscopically characterized by dotted vessels and yellow scales, whereas ER was typified by a characteristic pattern of vascular polygons. Sarcoidosis and LV very commonly exhibited orange-yellowish areas and linear branching vessels. Features related to follicle abnormalities and linear branching vessels were the most common dermoscopic criteria of DLE and GF. Conclusions This study provides new insights into the dermoscopic variability in common facial inflammatory dermatoses.

Granuloma annulare (GA) and necrobiosis lipoidica (NL) are the most common granulomatous skin diseases (GSD). Although GA usually follows a self-limiting course, it has been reported to occur in association with haematologic neoplasias and solid tumours. 1,2 The aetio- pathogenesis of NL is strongly associated with diabetes mellitus, and nonhealing ulcers and squamous cell carcinoma have been reported to develop occasionally on chronic NL lesions.

Background Among the various types of basal cell carcinoma, the sclerodermiform variant has a high risk of recurrence and local invasiveness. A systematic description of the dermatoscopic features associated with specific body localization is lacking.Objectives To describe the clinical and dermoscopic features of sclerodermiform basal cell carcinoma (BCC) according to localization in the body confronting with superficial and nodular types.Methods Clinical and dermoscopic images of sclerodermiform, nodular and superficial BCCs were retrospectively evaluated to study the location in the various body districts, maximum diameter, clinical appearance of the lesion, features of edges and presence or absence of specific dermatoscopic criteria of BCCs.Results We examined 291 histopathologically proven BCCs showing that in nodular BCCs, classical arborizing vessels were more frequently found in the body macro-area (trunk and limbs; n = 46, 97.9%) than in the head/neck area (n = 43, 82.7%); within sclerodermiform BCCs, short arborizing vessels were found more frequently in the head/neck district (n = 35, 49.3%) than in the body (n = 6, 23.1%; P-value 0.02); within nodular BCCs, multiple blue-grey dots and globules were more frequently found on the trunk (n = 23, 48.9%) than in the head/neck district (n = 12, 23.1%; P-value 0.01). In sclerodermiform BCCs, ulceration was found more frequently in the head/neck district (n = 38, 53.5%) than in the body (n = 4, 15.4%; P-value > 0.01), and in superficial BCCs, ulceration was found more frequently in the head/neck district (n = 5, 38.5%) than in the body (n = 8, 9.8%; P-value 0.02).Conclusion Our study shows that superficial BCC are found frequently in the head/neck district dermoscopically characterized by ulceration and arborizing vessels; nodular BCCs are more frequently found in the body than in the head/neck district, and the dermoscopic pattern is characterized by the combination of three features: (i) classical arborizing vessels, (ii) multiple blue-grey dots and (iii) globules. Instead, sclerodermiform BCC is preferentially located in areas at high-moderate risk of recurrence; if pink-white areas and/or fine arborizing vessels are seen, clinicians should consider this diagnosis. Furthermore, location-specific dermatoscopic criteria have been described.