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Rosettes in 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. Created February 2019.


What are rosettes?

Rosettes are a specific form of a white shiny structure seen with polarised dermoscopy.  They are also known as four-dot clods.

What do rosettes look like through the dermatoscope?

Rosettes consist of four white dots arranged in a square resembling a four leaf clover and can only be seen with polarised light.  They are always oriented at the same angle.


In which lesions are rosettes found?

Although at first believed to be specific for actinic keratosis and squamous cell carcinoma, rosettes are sometimes seen in other lesions as well as in normal skin.  Rosettes are most commonly found in:

  • Actinic keratosis (AK)
  • Thin squamous cell carcinoma (SCC)
  • Sun damaged skin
  • Tumours such as basal cell carcinoma (BCC) and melanoma
  • Molluscum contagiosum
  • Dermatofibroma.  

What is the histological explanation of rosettes?

The exact histological explanation of rosettes is unclear but they are thought to be due to an interaction between polarised light and narrowed keratin-filled, or fibrotic adnexal openings. Haspeslagh et al found that small rosettes (0.1–0.2 mm) corresponded to concentric horny material in follicular and eccrine ducts at the infundibular level and larger rosettes (0.3–0.5 mm) to perifollicular concentric fibrosis [1].




  1. Haspeslagh M, Noë M, De Wispelaere I et al. Rosettes and other white shiny structures in polarized dermoscopy: histological correlate and optical explanation. J Eur Acad Dermatol Venereol. 2016 Feb;30(2):311-3. doi: 10.1111/jdv.13080. Epub 2015 Mar 19. Review. PubMed PMID: 25786770.

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