case_images: PMC7154274_01
case_images: a Clinical examination of a pink-violet oval lesion of the leg in a 65-year-old woman. b Dermoscopy showed the presence of a polymorphous vascular pattern (linear, looped, and coiled vessels) (red arrows). White and orange dots and clods can be detected (white arrows). c RCM mosaic (3 x 3 mm) revealed a typical honeycombing pattern at the spinous and granular layers of the epidermis, with several round dark oval structures consistent with comedo-like openings and the presence of elongated cords corresponding to hyperplastic epidermis, bulging against the packed papillae. d Inflammatory infiltrate in the epidermal layer can also be observed (arrows). e RCM block showing inflammatory infiltrate closer to epidermis thickening. f Histopathological examination illustrated hyperkeratosis, hypergranulosis, and variable acanthosis with focal parakeratosis of the epidermis. A dense lymphohistiocytic inflammatory infiltrate in a band-like horizontal disposition is also present.
case_images: cde-0012-0047-g01.jpg
case_images: PMC7154274_01_cde-0012-0047-g01.jpg
case_images: F1
case_images: A 65-year-old woman, without family history of skin cancer, presented with ta pink-violet solitary lesion on the leg of 2 years' duration (Fig. 1a). It showed the presence of multiple polymorphous vascular patterns (linear, looped, and coiled vessels) distributed in the entire lesion as well as white and orange dots and clods (Fig. 1b). RCM revealed a typical honeycombing pattern at both the spinous and granular layers of the epidermis, with several round-oval dark structures consistent with comedo-like openings, and the presence of elongated cords corresponding to acanthotic (hyperplastic) epidermis bulging against the packed papillae (Fig. 1c). RCM also showed an inflammatory infiltrate at the dermo-epidermal junction closer to bulging packed papillae (Fig. 1d). Histopathologic examination confirmed the diagnosis of LPLK (Fig. 1e).
case_images: PMC7154274_02
case_images: a Dermoscopic image showing pink structureless areas. b RCM mosaic showed the presence of oval hyperreflective structures corresponding to comedo-like openings. c RCM mosaic performed at a deeper level illustrated elongated cords, bulbous projections and, within the interpapillary spaces, several bright round cells, consisting in a brisk inflammatory infiltrate.
case_images: cde-0012-0047-g02.jpg
case_images: PMC7154274_02_cde-0012-0047-g02.jpg
case_images: F2
case_images: Dermoscopy revealed a polymorphic vascular pattern on a soft pink background and some light brown areas in the borders that could not be traced back to a real pigment network (Fig. 2a). We performed RCM showing the presence of a typical honeycombing pattern related to several round oval dark and hyper reflective oval structure, attributable to comedo-like openings (Fig. 2b). Moreover, an RCM mosaic performed at a deeper level revealed the presence of elongated cords, bulbous projections and, within the interpapillary spaces, several bright round cells, brisk inflammatory cells (Fig. 2c).