Diagnosing juvenile xanthogranuloma with reflectance confocal microscopy

Juvenile xanthogranuloma (JXG) is a type of non-Langerhans cell histiocytosis, in which dendrocytes proliferate and accumulate in the dermis. JXG most frequently occurs in infants and children, presenting as a pink or yellow papule or nodule on the head and neck that spontaneously resolves over time.1 A “setting sun” appearance, defined by a central orange-yellow papule or nodule surrounded by linear branched vessels and erythema, is the classic dermoscopic presentation of JXG. Microscopic evaluation is sometimes necessary to distinguish JXG from a congenital nevus, especially if pigmented.