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solar (senile) lentigo

Etiology: 1) localized proliferation of melanocytes due to chronic exposure to sunlight 2) predisposition in fair skinned individuals Epidemiology: 1) generally > 40 years of age 2) no sex preference 3) most common in Caucasians Pathology: - elongated rete ridges with increased melanocytes & hypermelanosis in the basal layer Clinical manifestations: 1) 1-3 cm brown macules, but may be up to 5 cm 2) light to dark brown. may be variegated 3) slightly irregular border 4) multiple scattered discrete lesions 5) lesions occur on sun-exposed areas - generally on extremities rather than trunk * images [3] Differential diagnosis: 1) seborrheic keratosis: (macules evolve into verrucous papules & plaques with 'stuck on' appearance. often on trunk) 2) pigmented actinic keratosis 3) lentigo maligna - solar lentigines > 1 cm in diameter or irregularly shaped [2] Management: - skin biopsy if malignancy suspected - cryotherapy, quality-switched laser therapy, or intense pulsed light if malignancy not a concern [4]

Related

actinic (solar) keratosis (AK) lentigo maligna seborrheic keratosis

General

lentigo; melanocytic macule

References

  1. Color Atlas & Synopsis of Clinical Dermatology, Common & Serious Diseases, 3rd ed, Fitzpatrick et al, McGraw Hill, NY, 1997, pg 236
  2. Medical Knowledge Self Assessment Program (MKSAP) 16, 19. American College of Physicians, Philadelphia 2012, 2021.
  3. DermNet NZ. Brown spots and freckles (images) http://www.dermnetnz.org/lesions/freckles.html
  4. Plensdorf S, Livieratos M, Dada N. Pigmentation Disorders: Diagnosis and Management. Am Fam Physician. 2017 Dec 15;96(12):797-804. PMID: 29431372 Free article. Review.