Original Article

Super-High Magnification Dermoscopy Can Help for the Diagnosis of Lentigo Maligna: a Pilot Study on 61 Cases

Author Affiliation(s)


Introduction: Facial lentigo maligna/lentigo maligna melanoma (LM/LMM) is a significant diagnostic clinical challenge and dermoscopy can help its diagnosis.

Objectives: The following study aimed to evaluate if super-high magnification dermoscopy at 400x can add further details for the diagnosis of the LM/LMM.

Methods: This is a retrospective observational, multicentric study enrolling patients who received a 20x and 400x (D400) magnification dermoscopic examination of facial skin lesions in clinical differential diagnosis with LM/LMM. Dermoscopic images were retrospectively evaluated by four observers for the presence/absence of nine 20x and ten 400x dermoscopic features. Univariate and multivariate analyses were carried out to find predictors of LM/LMM.

Results: We enrolled 61 patients with a single atypical skin lesion of the face, including 23 LMs and 3 LMMs. The presence of roundish and/or dendritic melanocytes (P < 0.001), irregular arrangement of melanocytes (P <0.001), irregular in shape and size melanocytes (P = 0.002), and folliculotropism of melanocytes (P <0.001) at D400 were more frequent in LM/LMM than other facial lesions. According to the multivariate analysis, roundish melanocytes at 400x dermoscopy were more indicative of LM/LMM (Odds Ratio-OR 49.25, 95% CI 8.75-513.2, P < 0.001), and sharply demarcated borders at 20x dermoscopy were more indicative of not-LM/LMM (OR 0.1, 95% CI 0.01-0.79, P = 0.038).

Conclusions: D400 can identify atypical melanocyte proliferation and folliculotropism that can help to identify LM/LMM together with conventional dermoscopy data. Our preliminary observations should be confirmed by larger studies.

Keywords : Dermoscopy, super high magnification, melanocyte, lentigo maligna, melanoma


1. Iannacone MR, Youlden DR, Baade PD, Aitken JF, Green AC. Melanoma incidence trends and survival in adolescents and young adults in Queensland, Australia. Int J Cancer 2015; 136: 603-9. 2. Sacchetto L, Zanetti R, Comber H, et al. Trends in incidence of thick, thin and in situ melanoma in Europe. Eur J Cancer 2018; 92: 108-18. 3. Ferlay J SH, Bray F, et al. GLoBoCanN Cancer incidence and mortality Worldwide: IARC CancerBase No. 10. Lyon, France: international agency for Research on Cancer; 2010. Available at: (last accessed 1 December 2021). 4. Rapporto AIOM-AIRT 2017.: Available at: _del_cancro.pdf. (last accessed 1 December 2021). 5. Dabouz F, Barbe C, Lesage C, et al. Clinical and histological features of head and neck melanoma: a population-based study in France. Br J Dermatol 2015; 172: 707-15. 6. Robinson M, Primiero C, Guitera P, et al. Evidence-Based Clinical Practice Guidelines for the Management of Patients with Lentigo Maligna. Dermatology (Basel, Switzerland) 2020; 236: 111-6. 7. Lachiewicz AM, Berwick M, Wiggins CL, Thomas NE. Survival differences between patients with scalp or neck melanoma and those with melanoma of other sites in the Surveillance, Epidemiology, and End Results (SEER) program. Archives of dermatology 2008; 144: 515-21. 8. International Agency for Research on Cancer (IARC) W. Cancer incidence in five continents CI5plus: IARC CancerBase No 9 2018; Available at: http://ci5.iarc.f r/CI5plus/Default.aspx (last accessed 1 December 2021). 9. Lee KA, Nathan P. Cutaneous Melanoma - A Review of Systemic Therapies. Acta dermato-venereologica 2020; 100: adv00141. 10. Jerant AF, Johnson JT, Sheridan CD, Caffrey TJ. Early detection and treatment of skin cancer. American family physician 2000; 62: 357-68, 75-6, 81-2. 11. Tanaka M, Sawada M, Kobayashi K. Key points in dermoscopic differentiation between lentigo maligna and solar lentigo. J Dermatol 2011; 38: 53-8. 12. Stante M, Giorgi V, Stanganelli I, Alfaioli B, Carli P. Dermoscopy for early detection of facial lentigo maligna. Br J Dermatol 2005; 152: 361-4. 13. Kasprzak JM, Xu YG. Diagnosis and management of lentigo maligna: a review. Drugs in context 2015; 4: 212281. 14. Cinotti E, Fiorani D, Labeille B, et al. The integration of dermoscopy and reflectance confocal microscopy improves the diagnosis of lentigo maligna. Journal of the European Academy of Dermatology and Venereology : JEADV 2019; 33: e372-e4. 15. Cinotti E, Labeille B, Debarbieux S, et al. Dermoscopy vs. reflectance confocal microscopy for the diagnosis of lentigo maligna. J Eur Acad Dermatol 2018; 32: 1284-91. 16. Cinotti E, Rossi R, Ferrara G, Tognetti L, Rubegni P, Perrot JL. Image Gallery: Super-high magnification dermoscopy can identify pigmented cells: correlation with reflectance confocal microscopy. Br J Dermatol 2019; 181: e1-e. 17. Cinotti E, Tognetti L, Campoli M, et al. Super-high magnification dermoscopy can aid the differential diagnosis between melanoma and atypical naevi. Clinical and experimental dermatology 2021; 46: 1216-22. 18. Lallas A, Lallas K, Tschandl P, et al. The dermoscopic inverse approach significantly improves the accuracy of human readers for lentigo maligna diagnosis. Journal of the American Academy of Dermatology 2021; 84: 381-9. 19. Dika E, Lambertini M, Patrizi A, et al. Folliculotropism in head and neck lentigo maligna and lentigo maligna melanoma. J Dtsch Dermatol Ges 2021; 19: 223-9. 20. Akay BN, Kocyigit P, Heper AO, Erdem C. Dermatoscopy of flat pigmented facial lesions: diagnostic challenge between pigmented actinic keratosis and lentigo maligna. Br J Dermatol 2010; 163: 1212-7.

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