Pigmented macules on the head and neck

Abstract

Introduction: Differentiating early melanoma from other flat pigmented lesions on the head and neck is challenging both clinically and dermoscopically, partly due to the wide differential diagnosis and the lack of specific diagnostic algorithms. Objectives: To review publications covering the dermoscopic features of pigmented macules on the head and neck. Methods: Embase and PubMed (Medline) database from Jan 2015 to Jan 2021 were searched using a four-step search. Keywords used were dermoscopy/dermatoscopy or epiluminescence microscopy, lentigo maligna (LM), lentigo maligna melanoma (LMM), lichen-planus-like-keratosis (LPLK), solar lentigo (SL), seborrhoeic keratosis (SK), pigmented actinic keratosis (PAK), pigmented Bowen’s disease (pBD), pigmented intraepidermal carcinoma (pIEC) and head and neck. Results: The commonest reported dermoscopic features of facial melanoma were irregular dots, atypical dots/globules, asymmetric pigmented follicular openings (APFO), rhomboid grey/ black structures, increased vascular network, brown globules/dots and a pattern of circles. Pseudopods, radial streaming, blue white veil, irregular blotches, scar-like depigmentation and atypical pigment network  were recorded in low frequencies. For PAK, pBD and pIEC perifollicular erythema, white/yellow surface scale, linear wavy vessels around hair follicles, hair follicular openings surrounded by a white halo, evident follicles or follicular or keratotic plugs, rosette sign and sharply demarcated borders were the salient features. Conclusions: Further studies are needed to determine the dermoscopic criteria for pigmented melanocytic and non-melanocytic lesions on the head and neck. Furthermore, there is a gap in the knowledge of site-specific dermoscopic features on specific sites, namely ears, nose, cheeks, scalp and neck which will also benefit from further studies.