Pigmented demodicosis presenting as lentigo maligna diagnosed by reflectance confocal microscopy

The differential diagnosis between benign pigmented macules and lentigo maligna (LM) is clinically challenging. The presence of pigmented circles around hair follicles is an important dermoscopic clue for the diagnosis of LM. Here we report on a woman with a pigmented macule of the face with perifollicular circles for whom the diagnosis of LM was suspected. Instead, reflectance confocal microscopy diagnosed pigmented demodicosis, spared an unnecessary biopsy, and deciphered the mechanisms of hyperpigmentation.