"Chasing Rainbows" Beyond Kaposi Sarcoma's Dermoscopy: A Mini-Review

Abstract

The dermoscopic rainbow pattern (RP), also known as polychromatic pattern, is characterized by a multicolored appearance, resulting from the dispersion of polarized light as it penetrates various tissue components. Its separation into different wavelengths occurs according to the physics principles of scattering, absorption, and interference of light, creating the optical effect of RP. Even though the RP is regarded as a highly specific dermoscopic indicator of Kaposi's sarcoma, in the medical literature, it has also been documented as an atypical dermoscopic finding of other non-Kaposi skin entities. We aim to present two distinct cases-a pigmented basal cell carcinoma (pBCC) and an aneurysmatic dermatofibroma-that exhibited RP in dermoscopy and to conduct a thorough review of skin conditions that display RP, revealing any predisposing factors that could increase the likelihood of its occurrence in certain lesions. We identified 33 case reports and large-scale studies with diverse entities characterized by the presence of RP, including skin cancers (Merkel cell carcinoma, BCC, melanoma, etc.), adnexal tumors, special types of nevi (blue, deep penetrating), vascular lesions (acroangiodermatitis, strawberry angioma, angiokeratoma, aneurismatic dermatofibromas, etc.), granulation tissue, hypertrophic scars and fibrous lesions, skin infections (sporotrichosis and cutaneous leishmaniasis), and inflammatory dermatoses (lichen simplex and stasis dermatitis). According to our results, the majority of the lesions exhibiting the RP were located on the extremities. Identified precipitating factors included the nodular shape, lesion composition and vascularization, skin pigmentation, and lesions' depth and thickness. These parameters lead to increased scattering and interference of light, producing a spectrum of colors that resemble a rainbow.

Keywords: dermatopathology; dermoscopy; polychromatic pattern; rainbow pattern; skin cancer.

Figure 3

(A) Dermoscopy of Lichen planus in an Indian patient exhibiting PR (blue arrow) and peripheral pigmentation. (B) Dermoscopy of a post-burn hypertrophic scar presenting multiple iridescent areas.

Figure 1

Dermoscopic (A) and histopathology (B) (H&E, 4Χ magnification) images of a nodular pBCC, which displayed PR during the dermoscopy examination.

Figure 2

Dermoscopy of a hemosiderotic dermatofibroma, displaying RP in the center of the lesion: (A) histopathology of the tumor showed dense fibrohistiocytic proliferation, scattered hemosiderin deposition, and a vessel filled with erythrocytes (B) (H&E 20X magnification).