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Subjects/Dermatology/Melasma
Melasma
medium
hand Dermatology

Histopathological examination of a skin biopsy from a patient with melasma would most likely reveal which of the following findings?

A. A. Increased number of melanocytes in the basal layer with normal melanin content.
B. B. Normal number of melanocytes with increased melanin content in the basal and suprabasal layers.
C. C. Decreased number of melanocytes with melanin incontinence in the dermis.
D. D. Increased number of melanocytes with melanin incontinence in the dermis and solar elastosis.

Explanation

Histopathologically, melasma is characterized by an increased number of functionally active melanocytes (though the absolute number may not always be significantly increased, their activity is) and increased melanin production, primarily in the basal layer. A key feature, especially in dermal and mixed types, is melanin incontinence, where melanin pigment falls into the superficial dermis and is phagocytosed by dermal macrophages (melanophages). Solar elastosis, indicating chronic sun exposure, is also a common associated finding. Option B describes post-inflammatory hyperpigmentation more accurately. Option A is incorrect as melanin content is increased. Option C is incorrect as melanocyte number is not decreased.

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