These pigmented lesions are seen mainly on the face and back of severely sun damaged elderly patients. Unlike a solar lentigo or lentigo simplex they have varying pigmentation and areas of regression. These regressed areas can be pale or grey. If grey then dermatoscopically there may be structures called polygons, 3-5 sided figures with straight edges. Off the face polygons are a good marker of lentiginous melanoma. Histologically these lesions show proliferation of individual atypical melanocytes along the dermo epidermal junction and down the infundibulum of hair follicles. There is very little nesting of these atypical melanocytes or evidence of upward Pagetoid spread. The histological picture is virtually the same as lentigo maligna.
Look at the presentation below and then view the Virtual Slides.
Acral lentiginous melanoma in situ
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