Derm Cases · Dermatology / Photodamage / Skin cancer vigilance
OSCE — age spots on hands and face: solar lentigo vs lentigo maligna
An 8-minute OSCE station on solar lentigo recognition, differentiation from lentigo maligna, cosmetic treatment options (cryotherapy, lasers, peels), and photoprotection counselling.
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Study tools
Target exams
NEET-PGINICETUSMLEPLABMRCP
Prompt
An 8-minute OSCE station on solar lentigo recognition, differentiation from lentigo maligna, cosmetic treatment options (cryotherapy, lasers, peels), and photoprotection counselling.
Brief (to candidate)
A 68-year-old has multiple uniform light-brown flat macules on the dorsa of the hands and cheeks ("liver spots"). One larger cheek macule has become asymmetric with colour variegation over a year. You have 8 minutes to separate solar lentigo from lentigo maligna and plan safe management.
[5]Candidate instructions
- Define solar lentigo and its UV pathogenesis.
- List features that make a macule not a simple solar lentigo.
- State when to biopsy.
- Outline cosmetic treatments for classic benign lesions.
- Counsel photoprotection and surveillance.
Examiner checklist (mark each domain / 10)
| Domain | Key actions expected |
|---|---|
| Recognition | Uniform light-brown flat macules on chronic sun-exposed skin (hands, face, forearms); older adults; "age/liver/sun spots"; benign UV-driven melanocyte proliferation without obligatory melanoma transformation pathway of CMN-style risk |
| Not melanoma precursors as a class | Classic solar lentigines are benign cosmetic lesions; still require morphologic vigilance on photoaged skin where lentigo maligna coexists |
| Red flags / LM | Irregular border, variegated colour, large size, change, asymmetric growth → consider lentigo maligna (melanoma in situ) → biopsy, do not cryotherapy-blind treat[5] |
| Treatment of benign SL | Patient preference: observation, cryotherapy, Q-switched/pigment lasers, peels, topical lighteners/retinoids; set expectations for recurrence and hypopigmentation after cryo[1][3][4] |
| Prevention | Broad-spectrum sunscreen, clothing, behaviour change; new lesions expected with cumulative photodamage |
| Communication | Explain benign nature of uniform lesions while refusing to "freeze everything irregular" without diagnosis |
Model key actions
- Reassure on uniform hand solar lentigines and offer optional cosmetic care.[1]
- Biopsy the irregular changing facial macule for possible lentigo maligna.[5]
- Photoprotection for field photodamage.
Common errors
- Cryotherapy of irregular facial macules without excluding LM.
- Calling all brown spots "melanoma risk" without clinical nuance.
- No photoprotection counselling.
- Confusing seborrhoeic keratosis/lentigo maligna/solar lentigo patterns.
References4ShowHide
- [1]Mardani G, Nasiri MJ, Namazi N, et al. Treatment of Solar Lentigines: A Systematic Review of Clinical Trials. Journal of cosmetic dermatology, 2025.PMID 40145274
- [3]Zouboulis CC. [Cryosurgery in dermatology]. Der Hautarzt; Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete, 2015.PMID 26497955
- [4]Zouboulis CC. Cryosurgery in dermatology. European journal of dermatology : EJD, 1998.PMID 9854156
- [5]Kallini JR, Jain SK, Khachemoune A. Lentigo maligna: review of salient characteristics and management. American Journal of Clinical Dermatology, 2013.PMID 24019181