Description: Multiple grey dots aggregated around the hair follicles and asymmetric pigmented follicular openings.

History:

She has had longstanding pigmented lesion on her right malar area for more than five years which has been slowly increasing in size and darkening in pigmentation.Her skin phototype is I-II.She has no relevant history of skin cancer.

Histopathology:    Areas at least amounting to LENTIGO MELANOMA,CLARK LEVEL I,but with possible focal early LEVEL II,and features of patchy regression.

Schiffner R et al.described the "Progression model of lentigo maligna" and Stolz W also described the four characteristic features of lentigo maligna :

Asymmetric pigmented follicular openings,multiple gray dots and globules,dark rhomboidal structures and homogenous brown to dark areas occluding the follicular opening with an irregular outline.

APFOs forming an annular-granular pattern (Cognetta sign) is quite common in lentigo maligna but rare in pigmented actinic keratosis and lentigo senilis(flat seborrheic keratosis).