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An 82-year-old man with Fitzpatrick skin type III presented for the evaluation of a lesion on the left upper back. A scaly pink papule was observed (Figure 1). The differential diagnosis included squamous cell carcinoma (SCC), actinic keratosis, basal cell carcinoma, and amelanotic melanoma. On dermoscopy, multiple coiled blood vessels (also termed glo-merular vessels) were scattered across the papule (Figure 2) [1].

A pink papule on the back of an 82-year-old man: an example of the buttonhole sign on reflectance confocal microscopy