Juvenile Xanthogranuloma: Dermoscopic Pattern

Palmer and Bowling [1] have recently described the dermoscopic features in 3 cases of juvenile xanthogranuloma (JXG). A dermoscopic pattern characterized by orange-yellow background with ‘clouds’ of paler yellow deposits was observed in all patients. We have had recent occasion to observe many cases of single and multiple JXG and noted a further constant dermoscopic feature, namely branched and linear vessels running from the periphery to the centre of the lesions. This feature disappeared when slight pressure was exerted on the dermoscope ( fig. 1 ). We therefore wonder if the absence of a vascular pattern in the image of JXG proposed by Palmer and Bowling was simply due to pressure on the lesion with the dermoscope that could have caused ischaemia. This idea is supported by the fact that the authors described the growths clinically as yellowred papulonodules, but on dermoscopic analysis the lesions only showed orange-yellow setting-sun colouration. Although our observation may seem scientifically trivial, in our opinion it is important for a complete definition of the dermoscopic picture of JXG and to avoid that such methodological errors prejudice the correct dermoscopic analysis of lesions, such as amelanotic melanoma, a correct diagnosis of which depends on evaluation/detection of the dermoscopic vascular pattern [2, 3] . Published online: November 10, 2008