Solar lentigo (Actinic lentigo

Deba P Sarma, MD Omaha

F 71, left dorsal forearm

Location: Sun-exposed areas-face, forearms, dorsal hand. Age: Rare before 50. After 70, more than 90% people with light skin may have solar lentigo. Clinical: Uniform, dark brown, non-infiltrated macule of irregular outline, size: minute to > 1cm. MIcroscopic features: -Flat epidermis. -Acanthosis with elongated rete ridges with club-shaped, tortuous or bud-like extensions. -Elongated rete ridges are composed of pigmented basaloid cells. Melanocytes are normal or increased in number. -No melanocytic nests present at the junction. -Dermis shows actinic degeneration. ( DO NOT DIAGNOSE SOLAR LENTIGO IF THE DERMIS DOES NOT SHOW SOLAR DEGENERATION) Solar lentigo is not a melanocytic disorder. Solar lentigo may evolve into reticulated pigmented seborrheic keratosis with raised epidermis. Solar lentigo is usually not a precursor of any malignant tumor. Very rarely, a lentigo maligna may arise in such a lesion of long duration. In xeroderma pigmentosum, melanoma may arise in pre-existing solar lentigo.