Background

Fluorescence-advanced videodermatoscopy (FAV) is a new non-invasive high-resolution skin imaging technique to assess pigmented lesions in conjunction with the clinical exam and dermatoscopy.

Objectives

This is the first prospective study to identify morphologic descriptors and standardised terminology to examine facial pigmented lesions using FAV. The objectives were to identify FAV indicators,which can assist physicians in diagnosing suspicious flat facial pigmented lesions.

Methods

Consecutive equivocal pigmented lesions were retrospective analyzed. Histopathological examination was performed for all the lesions.The main cytomorphological and cytoarchitectural FAV features were described and correlated with histopathological characteristics.

Results

From January to October 2020, 21 consecutive clinically suspected pigmented lesions in 20 patients were analysed using dermatoscopy and FAV and then surgically excised. Histopathological examination identified lentigo maligna(LM), lentigo maligna melanoma (LMM), solar lentigo(SL), flat seborrheic keratosis (SK), and pigmented actinic keratosis(PAK). Thirteen malignant melanocytic lesions were removed (11 LM, 2 LMM), two were diagnosed as PAK, and the remaining six pigmented lesions were SL-SKs. With FAV large ovoid pleomorphic and dendritic cells arranged in the intrafollicular disposition, are typical of most malignant melanocytic lesions(12/13, 92,3%). No benign lesions displayed these features. In dermatoscopy, this folliculotropism corresponded to the presence of an annular–granular pattern with slate grey dots that were aggregated asymmetrically around follicular openings.

Conclusions

FAV features can provide an improved diagnostic approach in the differential diagnosis of flat pigmented facial lesions.