This 45 year old woman presented with large patches or thin plaques of hypopigmentation. Scale was not prominent. The clinical differential diagnosis included tinea versicolor and confluent and reticulated papillomatosis. Tinea versicolor is in the normal skin differential (on histology) as there are often no findings at low power. Fungal elements are often numerous at high power, within the stratum corneum, yet these do not elicit a brisk inflammatory response, like dermatophytes often do. The morphology of the organisms is described as spaghetti and meatballs, but in my experience, it is more like penne and meatballs.
At scanning power, this biopsy is unremarkable. The stratum corneum, epidermis and dermis appear within normal limits. A significant inflammatory infiltrate is not seen.