Rosettes in dermatology: A polarized perspective on diagnosis and clinical significance

Dermoscopy has revolutionized dermatological diagnostics by enabling the visualization of subsurface skin structures.Among various dermoscopic features, rosettes have gained attention due to their distinctive appearance and diagnostic implications. 1Figure 1 illustrates the characteristic appear ance of rosettes, as seen in polarized light dermoscopy.This review summarizes existing literature on rosettes in dermatology, highlighting their broader clinical relevance across disease categories and comparing findings with earlier fragmented reports.While prior mentions of rosettes have appeared in case series and reviews focused on actinic keratoses, this review compiles evidence across neoplastic, inflammatory, infectious, and vascular conditions, offering a more comprehensive, structured overview.Recognizing the spectrum of conditions associated with rosettes is crucial for accurate diagnosis and management.The emergence of polarized dermoscopy has facilitated the detection of these structures, which remain invisible under nonpolarized light. 2 This review synthesizes existing literature on rosettes in dermatology, highlighting their clinical relevance and differential diagnosis. MethodologyA systematic literature search was conducted following the Preferred Reporting Items for Systematic Reviews and MetaAnalyses guidelines. 3The search was performed in December 2024 across MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science.Keywords used included "rosettes, " "dermoscopy, " "polarized light, " "cutaneous neoplasms, " and "inflammatory skin diseases." Studies published in English, reporting rosettes in various dermatological conditions, were included, while reviews, editorials, and nonEnglish articles were excluded.Both observational and casecontrol studies were considered.Reference lists of relevant studies were manually searched for additional articles.The search yielded 73 articles meeting the inclusion criteria, identifying 47 distinct diagnoses associated with rosettes.These conditions were categorized as neoplastic, inflammatory, infectious, and vascular. Neoplastic conditionsKeratinizing neoplasms, such as actinic keratosis (AK) and squamous cell carcinoma (SCC), were most frequently reported, 19 of the 73 articles (26%) documenting rosettes in these lesions. 4Histopathologically, rosettes in these conditions correlate with corneal lamellae and areas of significant