Elastosis perforans serpiginosa – low magnification
LEGEND
Hyperkeratotic crust with transepidermal elimination of elastic fibers
Invagination of the epidermis with hyperplasia. The epidermis engulfs or pinches the dermis at the site of perforation (crab claw–like shape).
Elastosis perforans serpiginosa – high magnification
LEGEND
Infiltrate of macrophages, multinucleated giant cells, lymphocytes, or neutrophils at the site of perforation in the dermis
Presence of twisted, eosinophilic elastin fragmented into small pieces in the superficial dermis
Sometimes, elastophagocytosis is observed, meaning that elastin is phagocytosed by macrophages.
Elastosis perforans serpiginosa

Verhoeff-Van Gieson stain is positive and stains elastic fibers black.