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Asymmetrical pigmented follicular openings dermoscopy

Author: Naomi Ashman, Dermoscopist, Torbay Skin, Auckland, New Zealand. DermNet New Zealand Editor in Chief: Adjunct A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. Copy edited by Gus Mitchell. Created January 2019.


What are asymmetrical pigmented follicular openings?

Asymmetrical pigmented follicular openings (APFOs) are curved or crescent-shaped areas of pigment partially surrounding the adnexal openings of the face.

Dermoscopic features of asymmetrical pigmented follicular openings

Asymmetrical pigmented follicular openings are seen through the dermatoscope as pigmented crescents at the periphery of a follicle. They can be the same colour as the surrounding pigment as in a solar lentigo, or heavily pigmented, often with a greyish hue as seen in lentigo maligna melanoma [1]. 

Lesions characterised by asymmetrical pigmented follicular openings

Asymmetrical pigmented follicular openings are characteristic of:

Asymmetrical pigmented follicular openings in lentigo maligna

They can also occur in:

Although asymmetrical pigmented follicular openings are often said to be a clue to melanoma in situ, the clue actually has poor specificity [2].

Asymmetrical pigmented follicular openings in other lesions

What is the histological explanation for asymmetrical pigmented follicular openings?

Asymmetrical pigmented follicular openings are due to abnormal melanophages spread asymmetrically up the hair follicle. In lentigo maligna, abnormal melanocytes may arise from stem cells in the follicular infundibulum.

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References

  1. Dermoscopedia contributors – Ralph Braun, Luc Thomas, Wilhelm Stolz. Lentigo Maligna. Dermoscopedia. Available at: https://dermoscopedia.org/w/index.php title=Lentigo_Maligna&oldid=16329 (accessed 25 August 2020).
  2. Kittler H, Rosendahl C, Cameron A, Tschandi P. Dermatoscopy, Pattern analysis of pigmented and non-pigmented lesions; 2nd edition. Facultas Verlags und Buchandels AG facultas Universitatsverlag, Vienna, Austria. 2016.

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