Volume 4, Issue 6, Pages (July 2018)

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Volume 4, Issue 6, Pages 568-572 (July 2018) Pigmented actinic lichen planus (PALP) mimicking lentigo maligna melanoma: Usefulness of in vivo reflectance confocal microscopy in diagnosis and follow-up Marina Venturini, MD, Ausilia Maria Manganoni, MD, Arianna Zanca, MD, Stefania Bassissi, MD, Laura Pavoni, MD, Salvador Gonzales, PhD, AnnaMaria Cesinaro, MD, PierGiacomo Calzavara-Pinton, MD JAAD Case Reports Volume 4, Issue 6, Pages 568-572 (July 2018) DOI: 10.1016/j.jdcr.2018.02.008 Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 1 A, Clinical evaluation found a patch of about 6 × 3 cm, slightly and irregularly pigmented on the right cheek. B, Dermoscopic pattern with diffuse peppering, hyperpigmented follicular opening (yellow arrows), and some hair follicles with central black dots (isobar sign) (red arrows). JAAD Case Reports 2018 4, 568-572DOI: (10.1016/j.jdcr.2018.02.008) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 2 RCM evaluation (mosaic 1 × 1 mm). A, Spongiotic epidermis (yellow circle) with exocitosis (yellow arrows) at granulosum/spinosum layer. B, Pleomorphic cells with enlarged refractile cytoplasm and evident nucleus corresponding to melanocytes (red arrows), associated with plump, bright round to polygonal non-nucleated cells corresponding to melanophages (blue arrows) and inflammatory infiltrate (yellow arrows) located at the dermoepidermal junction level. C, Papillary dermis showed horizontal blood vessels, aberrant extracellular matrix with thickening of collagen bundles, and lichenoid inflammatory infiltrate with periadnexal disposition mixed with some melanophages. D, Histopathologic analysis of PALP: at dermoepidermal junction focal and slight elongated ridges (hematoxylin-eosin, original magnification ×100). E, At the dermal level, small nests or isolated melanocytic cells together with melanophages and focal lichenoid inflammatory infiltrates with Civatte bodies. A prominent inflammatory infiltrate, composed by mixture of lymphocytes and histiocytes placed in periadnexal and perifollicular areas. Chronic actinic damage (solar elastosis) was also found (hematoxylin-eosin, original magnification ×200). F, Immunohistochemistry stain (MART-1 stain): strong Melan-A positivity (original magnification ×200). (D and E, Hematoxylin eosin stain; F, MART-1 stain; Original magnifications: D, ×100; E and F, ×200.) JAAD Case Reports 2018 4, 568-572DOI: (10.1016/j.jdcr.2018.02.008) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 3 Clinical improvement of the lesions 3 (A) and 6 (B) months after starting topical corticosteroids and sunscreen. C, Dermoscopic improvement after 6 months of topical corticosteroids: disappearing of peppering, irregular pigmentation, and isobar sign. D, RCM evaluation after 3 months of steroid therapy. Mosaic (3.5 × 3.5 mm) shows a clear improvement of inflammatory infiltrate. JAAD Case Reports 2018 4, 568-572DOI: (10.1016/j.jdcr.2018.02.008) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions