1
|
Pizzichetta MA, Polesel J, Perrot JL, Rubegni P, Stanganelli I, Magi S, Mazzoni L, Farnetani F, Pellacani G, Garutti M, Puglisi F, Cinotti E. The combination of dermoscopy and reflectance confocal microscopy increases the diagnostic confidence of amelanotic/hypomelanotic lentigo maligna. J Dermatol 2024; 51:714-718. [PMID: 38217366 DOI: 10.1111/1346-8138.17075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 01/15/2024]
Abstract
The dermoscopic diagnosis of amelanotic/hypomelanotic lentigo maligna/lentigo maligna melanoma (AHLM/LMM) may be very difficult in its early stages because of lack of pigment. Reflectance confocal microscopy (RCM) is an imaging technique that is especially helpful for the diagnosis of lentigo maligna. To determine the diagnostic performances of dermoscopy and RCM in the diagnosis of AHLM/LMMs we evaluated dermoscopic and RCM images of consecutive cases of histopathologically confirmed AHLM/LMMs, amelanotic/hypomelanotic basal cell carcinoma and squamous cell carcinoma (AHBCCs/AHSCCs), amelanotic/hypomelanotic benign lesions (AHBLs), and actinic keratoses (AKs) from five participating centers. Sensitivity, specificity, accuracy, predictive values, and level of diagnosis confidence were calculated for both diagnostic procedures. Both dermoscopy and RCM showed diagnostic performance >97% in the diagnosis of AHLM/LMMs versus AHBCC/AHSCCs and their combination slightly improved diagnostic performance, with accuracy increasing from 98.0% to 99.1%. Similarly, RCM in combination with dermoscopy showed a tiny increase in the diagnostic performance in the diagnosis of AHLM/LMMs versus AHBLs (accuracy increased from 87.2% to 88.8%) and versus AKs (accuracy increased from 91.4% to 93.4%). Although the increase in diagnostic performance due to RCM was modest, the combination of dermoscopy and RCM greatly increased the level of confidence; high confidence in the diagnosis of AHLM/LMMs versus AHBLs increased from 36.2% with dermoscopy alone to 76.6% with dermoscopy plus RMC. Based on our results, dermoscopy and RCM should be complementary to improve not only diagnostic accuracy but also the level of diagnostic certainty in the diagnosis of AHLM/LMMs.
Collapse
MESH Headings
- Humans
- Dermoscopy
- Microscopy, Confocal/methods
- Skin Neoplasms/pathology
- Skin Neoplasms/diagnostic imaging
- Skin Neoplasms/diagnosis
- Hutchinson's Melanotic Freckle/pathology
- Hutchinson's Melanotic Freckle/diagnosis
- Hutchinson's Melanotic Freckle/diagnostic imaging
- Sensitivity and Specificity
- Diagnosis, Differential
- Female
- Aged
- Male
- Carcinoma, Basal Cell/diagnostic imaging
- Carcinoma, Basal Cell/pathology
- Carcinoma, Basal Cell/diagnosis
- Carcinoma, Squamous Cell/diagnostic imaging
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/diagnosis
- Middle Aged
- Keratosis, Actinic/diagnostic imaging
- Keratosis, Actinic/pathology
- Keratosis, Actinic/diagnosis
- Melanoma, Amelanotic/pathology
- Melanoma, Amelanotic/diagnostic imaging
- Melanoma, Amelanotic/diagnosis
- Aged, 80 and over
- Predictive Value of Tests
Collapse
Affiliation(s)
- Maria Antonietta Pizzichetta
- Department of Dermatology, University of Trieste, Trieste, Italy
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano IRCCS, Istituto di ricovero e cura a carattere scientifico, Aviano, Italy
| | - Jerry Polesel
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano IRCCS, Aviano, Italy
| | - Jean Luc Perrot
- Department of Dermatology, University Hospital of Saint Etienne, Saint-Etienne, France
| | - Pietro Rubegni
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy
| | - Ignazio Stanganelli
- Department of Dermatology, University of Parma-Skin Cancer Unit, Istituto Scientifico Romagnolo per lo Studio dei Tumori "Dino Amadori" IRCCS, Meldola, Italy
- Skin Cancer Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori", Meldola, Italy
| | - Serena Magi
- Skin Cancer Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori", Meldola, Italy
| | - Laura Mazzoni
- Skin Cancer Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori", Meldola, Italy
| | - Francesca Farnetani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Pellacani
- Department of Dermatology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Mattia Garutti
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano IRCCS, Istituto di ricovero e cura a carattere scientifico, Aviano, Italy
| | - Fabio Puglisi
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano IRCCS, Istituto di ricovero e cura a carattere scientifico, Aviano, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Elisa Cinotti
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy
| |
Collapse
|
2
|
Karponis D, Stratigos IA, Joshy J, Craig PJ, Mistry K, van Bodegraven B, Venables ZC, Levell NJ. Lentigo maligna: a review. Clin Exp Dermatol 2024; 49:218-225. [PMID: 37966718 DOI: 10.1093/ced/llad394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/19/2023] [Accepted: 11/07/2023] [Indexed: 11/16/2023]
Abstract
Lentigo maligna (LM) is a melanoma in situ with distinct clinical features and histology. It commonly affects men after the sixth decade of life. Incidence rates of LM have increased based on early 21st century data from different countries; however, data are suboptimal. Data from England show a plateauing crude incidence between 2013 and 2019. By comparison, invasive melanoma and other types of melanoma in situ commonly appears in younger age groups (median age 58 and 67 years old, respectively) and incidence is rising. The most important risk factors for LM include fair skin and cumulative ultraviolet solar radiation exposure. Although LM is limited to the epidermis and connected skin adnexa, it may progress to invasive LM melanoma. The reported rate of malignant progression varies, reflecting a challenge for LM epidemiology research as often lesions are removed on diagnosis. LM poses a challenge in diagnosis and management. Although it can be diagnosed clinically or dermoscopically, histopathological assessment of biopsied skin tissue remains the gold standard. Reflectance confocal microscopy allows for better appreciation of the complexity of LM at a cellular level, often progressing beyond clinical margins. Management of LM may involve Mohs micrographic surgery or excision, although recurrence may occur even with 5 mm clinical margins. Imiquimod cream may be effective, but incomplete treatment and recurrence has been reported. Conservative management with observation or radiotherapy may be used in selected patients' cases. Five-year net survival rates are excellent. This paper reviews the natural history, epidemiology, aetiology, pathogenesis, diagnosis and management of LM.
Collapse
Affiliation(s)
- Dimitrios Karponis
- Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, UK
| | | | - Jilse Joshy
- Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Paul J Craig
- Cellular Pathology, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Khaylen Mistry
- Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Birgitta van Bodegraven
- British Association of Dermatologists, London, UK
- National Disease Registration Service, Data and Analytics, NHS England, UK
| | - Zoe C Venables
- Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
- National Disease Registration Service, Data and Analytics, NHS England, UK
| | - Nick J Levell
- Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| |
Collapse
|
3
|
Guida S, Alma A, Fiorito F, Megna A, Chester J, Kaleci S, Ciardo S, Manfredini M, Rongioletti F, Perrot JL, Rubegni P, Chello C, Cantisani C, Pellacani G, Cinotti E, Farnetani F. Lentigo maligna and lentigo maligna melanoma in vivo differentiation with dermoscopy and reflectance confocal microscopy: A retrospective, multicentre study. J Eur Acad Dermatol Venereol 2023; 37:2293-2300. [PMID: 37357442 DOI: 10.1111/jdv.19291] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 05/26/2023] [Indexed: 06/27/2023]
Abstract
INTRODUCTION Dermoscopic predictors of lentigo maligna (LM) and lentigo maligna melanoma (LMM) have been recently reported, but these have not been reported in reflectance confocal microscopy (RCM). OBJECTIVES (i) To validate dermoscopic predictors for LM/LMM, (ii) to identify RCM patterns in LM and LMM, and (iii) correlations between dermoscopic and RCM features in LM and LMM. MATERIALS AND METHODS A retrospective, multicentre study of consecutive lesions with histologically proven LM or LMM subtypes of the head and face, with complete sets of dermoscopic and RCM images. RESULTS A total of 180 lesions were included (n = 40 LMM). Previously reported differential dermoscopic features for LM subtypes were confirmed. Other features significantly associated with LMM diagnosis included irregular hyperpigmented areas, shiny white streaks, atypical vessels and light brown colour at dermoscopy and medusa head-like structures, dermal nests and nucleated cells within the papillae at RCM (p < 0.05). Correlations among LM lesions between dermoscopic and RCM features included brown to-grey dots and atypical cells (epidermis), grey colour and inflammation and obliterated follicles and medusa head-like structures. Among LMM lesions, significant correlations included obliterated follicles with folliculotropism, both irregular hyperpigmented areas and irregular blotches with widespread atypical cell distribution (epidermis), dermal nests and nucleated cells within the papillae (dermis). Irregular blotches were also associated with medusa head-like structures (dermal epidermal junction [DEJ]). CONCLUSIONS Dermoscopic and RCM features can assist in the in vivo identification of LM and LMM and many are correlated. RCM three-dimensional analysis of skin layers allows the identification of invasive components in the DEJ and dermis.
Collapse
Affiliation(s)
- Stefania Guida
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Dermatology Clinic, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Alma
- Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Flavio Fiorito
- Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Megna
- Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Johanna Chester
- Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Shaniko Kaleci
- Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Silvana Ciardo
- Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Manfredini
- Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Franco Rongioletti
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Dermatology Clinic, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Jean L Perrot
- Department of Dermatology, University Hospital of Saint Etienne, Saint-Etienne, France
| | - Pietro Rubegni
- Dermatology Section, Department of Medical, Surgical and Neurological Science, S. Maria alle Scotte Hospital, University of Siena, Siena, Italy
| | - Camilla Chello
- Dermatology Clinic, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Carmen Cantisani
- Dermatology Clinic, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Giovanni Pellacani
- Dermatology Clinic, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Elisa Cinotti
- Dermatology Section, Department of Medical, Surgical and Neurological Science, S. Maria alle Scotte Hospital, University of Siena, Siena, Italy
| | - Francesca Farnetani
- Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|
4
|
Tognetti L, Cartocci A, Żychowska M, Savarese I, Cinotti E, Pizzichetta MA, Moscarella E, Longo C, Farnetani F, Guida S, Paoli J, Lallas A, Tiodorovic D, Stanganelli I, Magi S, Dika E, Zalaudek I, Suppa M, Argenziano G, Pellacani G, Perrot JL, Miracapillo C, Rubegni G, Cevenini G, Rubegni P. A risk-scoring model for the differential diagnosis of lentigo maligna and other atypical pigmented facial lesions of the face: The facial iDScore. J Eur Acad Dermatol Venereol 2023; 37:2301-2310. [PMID: 37467376 DOI: 10.1111/jdv.19360] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/07/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Due to progressive ageing of the population, the incidence of facial lentigo maligna (LM) of the face is increasing. Many benign simulators of LM and LMM, known as atypical pigmented facial lesions (aPFLs-pigmented actinic keratosis, solar lentigo, seborrheic keratosis, seborrheic-lichenoid keratosis, atypical nevus) may be found on photodamaged skin. This generates many diagnostic issues and increases the number of biopsies, with a subsequent impact on aesthetic outcome and health insurance costs. OBJECTIVES Our aim was to develop a risk-scoring classifier-based algorithm to estimate the probability of an aPFL being malignant. A second aim was to compare its diagnostic accuracy with that of dermoscopists so as to define the advantages of using the model in patient management. MATERIALS AND METHODS A total of 154 dermatologists analysed 1111 aPFLs and their management in a teledermatology setting: They performed pattern analysis, gave an intuitive clinical diagnosis and proposed lesion management options (follow-up/reflectance confocal microscopy/biopsy). Each case was composed of a dermoscopic and/or clinical picture plus metadata (histology, age, sex, location, diameter). The risk-scoring classifier was developed and tested on this dataset and then validated on 86 additional aPFLs. RESULTS The facial Integrated Dermoscopic Score (iDScore) model consisted of seven dermoscopic variables and three objective parameters (diameter ≥ 8 mm, age ≥ 70 years, male sex); the score ranged from 0 to 16. In the testing set, the facial iDScore-aided diagnosis was more accurate (AUC = 0.79 [IC 95% 0.757-0.843]) than the intuitive diagnosis proposed by dermatologists (average of 43.5%). In the management study, the score model reduced the number of benign lesions sent for biopsies by 41.5% and increased the number of LM/LMM cases sent for reflectance confocal microscopy or biopsy instead of follow-up by 66%. CONCLUSIONS The facial iDScore can be proposed as a feasible tool for managing patients with aPFLs.
Collapse
Affiliation(s)
- Linda Tognetti
- Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
| | - Alessandra Cartocci
- Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Magdalena Żychowska
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszów, Poland
| | - Imma Savarese
- Soc Dermatologia Pistoia-Prato, USL Toscana Centro, Pistoia, Italy
| | - Elisa Cinotti
- Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
| | - Maria Antonietta Pizzichetta
- Dermatology Clinic, Ospedale di Trieste, Trieste, Italy
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Elvira Moscarella
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Caterina Longo
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale, IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Farnetani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefania Guida
- Vita-Salute San Raffaele University, Milan, Italy
- Dermatology Clinic, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - John Paoli
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
- Department of Dermatology and Venereology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | | | - Ignazio Stanganelli
- Skin Cancer Unit, Scientific Institute of Romagna for the Study of Cancer, IRCCS, IRST, Meldola, Italy
- Department of Dermatology, University of Parma, Parma, Italy
| | - Serena Magi
- Skin Cancer Unit, Scientific Institute of Romagna for the Study of Cancer, IRCCS, IRST, Meldola, Italy
| | - Emi Dika
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
- Dermatology, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Iris Zalaudek
- Dermatology Clinic, Ospedale di Trieste, Trieste, Italy
| | - Mariano Suppa
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
- Groupe d'Imagerie Cutanée Non-Invasive, Société Française de Dermatologie, Paris, France
- Department of Dermatology, Institut Jules Bordet, Brussels, Belgium
| | | | - Giovanni Pellacani
- Department of Dermatology, Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy
| | - Jean Luc Perrot
- Dermatology Unit, University Hospital of St-Etienne, Saint Etienne, France
| | - Chiara Miracapillo
- Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
| | - Giovanni Rubegni
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Gabriele Cevenini
- Bioengineering and Biomedical Data Science Lab, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Pietro Rubegni
- Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
| |
Collapse
|
5
|
Gamo Villegas R, Floristán Muruzábal MU, Pampín Franco A. Perifollicular Radial Lines and Medusa Head-like Structures: Signs Suggesting Lentigo Maligna. Actas Dermosifiliogr 2023; 114:734. [PMID: 36243137 DOI: 10.1016/j.ad.2022.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/15/2022] [Accepted: 04/13/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- R Gamo Villegas
- Fundación Hospital Alcorcón, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
| | - M U Floristán Muruzábal
- Fundación Hospital Alcorcón, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - A Pampín Franco
- Fundación Hospital Alcorcón, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| |
Collapse
|
6
|
Gamo Villegas R, Floristán Muruzábal MU, Pampín Franco A. [Translated article] Perifollicular Radial Lines and Medusa Head-Like Structures: Signs Suggesting Lentigo Maligna. Actas Dermosifiliogr 2023; 114:T734. [PMID: 37442423 DOI: 10.1016/j.ad.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/13/2022] [Indexed: 07/15/2023] Open
Affiliation(s)
- R Gamo Villegas
- Fundación Hospital Alcorcón, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain.
| | - M U Floristán Muruzábal
- Fundación Hospital Alcorcón, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - A Pampín Franco
- Fundación Hospital Alcorcón, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| |
Collapse
|
7
|
Gouveia BM, Carlos G, Wadell A, Sinz C, Ahmed T, Lo SN, Rawson RV, Ferguson PM, Scolyer RA, Guitera P. In vivo reflectance confocal microscopy can detect the invasive component of lentigo maligna melanoma: Prospective analysis and case-control study. J Eur Acad Dermatol Venereol 2023; 37:1293-1301. [PMID: 36855833 PMCID: PMC10946995 DOI: 10.1111/jdv.18998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 02/08/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Lentigo maligna (LM), a form of melanoma in situ, has no risk of causing metastasis unless dermal invasive melanoma (LMM) supervenes. Furthermore, the detection of invasion impacts prognosis and management. OBJECTIVE To assess the accuracy of RCM for the detection of invasion component on LM/LMM lesions. METHODS In the initial case-control study, the performance of one expert in detecting LMM at the time of initial RCM assessment of LM/LMM lesions was recorded prospectively (n = 229). The cases were assessed on RCM-histopathology correlation sessions and a panel with nine RCM features was proposed to identify LMM, which was subsequently tested in a subset of initial cohort (n = 93) in the matched case-control study by two blinded observers. Univariable and multivariable logistic regression models were performed to evaluate RCM features predictive of LMM. Reproducibility of assessment of the nine RCM features was also evaluated. RESULTS A total of 229 LM/LMM cases evaluated by histopathology were assessed blindly and prospectively by an expert confocalist. On histopathology, 210 were LM and 19 were LMM cases. Correct identification of an invasive component was achieved for 17 of 19 LMM cases (89%) and the absence of a dermal component was correctly diagnosed in 190 of 210 LM cases (90%). In the matched case-control (LMM n = 35, LM n = 58), epidermal and junctional disarray, large size of melanocytes and nests of melanocytes were independent predictors of LMM on multivariate analysis. The interobserver analysis demonstrated that these three features had a fair reproducibility between the two investigators (K = 0.4). The multivariable model including those three features showed a high predictive performance AUC = 74% (CI 95% 64-85%), with sensitivity of 63% (95% CI 52-78%) and specificity of 79% (CI 95% 74-88%), and likelihood ratio of 18 (p-value 0.0026). CONCLUSION Three RCM features were predictive for identifying invasive melanoma in the background of LM.
Collapse
Grants
- Melanoma Institute Australia
- N/A MetaOptima Technology Incl., Hoffmann-La Roche Ltd, Evaxion, Provectus Biopharmaceuticals Australia, Qbiotics, Novartis, Merck Sharp & Dohme, NeraCare, AMGEN Inc., Bristol-Myers Squibb, Myriad Genetics, GlaxoSmithKline.
- APP1141295 NHMRC Practitioner Fellowship
Collapse
Affiliation(s)
- Bruna Melhoranse Gouveia
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Giuliana Carlos
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Andreanne Wadell
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- CHUS - Hôtel-Dieu, Sherbrooke, Québec, Canada
| | - Christoph Sinz
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Tasnia Ahmed
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Robert V Rawson
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, New South Wales, Australia
| | - Peter M Ferguson
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, New South Wales, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Pascale Guitera
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
8
|
Punchihewa N, Odhavji S, Upjohn E, Bekhor P. Immunostained Frozen Sections Vs Traditional Permanent Paraffin Sections for Lentigo Maligna Treated With Mohs Micrographic Surgery. Dermatol Surg 2022; 48:43-46. [PMID: 34772830 DOI: 10.1097/dss.0000000000003280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mohs micrographic surgery (MMS) has risen in popularity as a management option for treating lentigo maligna (LM) because of its ability to accurately detect subclinical spread while conserving tissue. The primary concern for opponents of MMS in melanoma remains the difficulty associated with interpretation of frozen sections compared with traditional paraffin sections; this has been made easier with the advent of immunostaining. OBJECTIVE Our study aims to assess the concordance in clearance reporting of LM in immunostained frozen sections compared with permanent paraffin sections and hematoxylin and eosin staining. METHODS We conducted a retrospective analysis of 38 LM cases treated by MMS between 2017 and 2020 in Melbourne, Australia. Immunostained frozen sections were assessed by a Mohs surgeon, whereas permanent paraffin sections were assessed by an external dermatopathologist. RESULTS We report 86% agreement in reporting of LM in immunostained frozen sections compared with permanent paraffin sections. In 5/38 cases, permanent paraffin sections were reported as clear for LM, but the Mohs surgeon had detected positive margins, requiring further excision. CONCLUSION For LM treated with MMS, there is a high agreement of clearance reporting between immunostained stained frozen sections and permanent paraffin sections without immunostaining; however, immunostained frozen sections may be more sensitive.
Collapse
Affiliation(s)
| | - Sonya Odhavji
- Skin Health Institute, Carlton, Melbourne, Australia
| | - Edward Upjohn
- Skin Health Institute, Carlton, Melbourne, Australia
| | - Philip Bekhor
- Skin Health Institute, Carlton, Melbourne, Australia
- Department of Paediatrics, Melbourne University, Royal Children's Hospital, Melbourne, Australia
| |
Collapse
|
9
|
Gradecki SE, Valdes-Rodriguez R, Wick MR, Gru AA. PRAME immunohistochemistry as an adjunct for diagnosis and histological margin assessment in lentigo maligna. Histopathology 2021; 78:1000-1008. [PMID: 33280156 DOI: 10.1111/his.14312] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 11/30/2020] [Accepted: 12/06/2020] [Indexed: 12/11/2022]
Abstract
AIMS Lentigo maligna (LM), the most common type of melanoma in situ, is a diagnostically challenging lesion for pathologists due to abundant background melanocytic hyperplasia in sun-damaged skin. Currently, no laboratory methods reliably distinguish benign from malignant melanocytes. However, preferentially expressed antigen in melanoma (PRAME) has shown promise in this regard, and could potentially be applied to diagnosis and margin assessment in difficult cases of LM. METHODS AND RESULTS Ninety-six cases with a diagnosis of LM (n = 77) or no residual LM (n = 19) following initial biopsy were identified and stained with an antibody directed towards PRAME. Immunohistochemistry (IHC) was scored as positive or negative, and measurement of histological margins by PRAME was performed and compared to the measurement of histological margins using conventional methods [haematoxylin and eosin (H&E) and/or sex-determining region Y-box 10 (SOX10) and/or Melan-A]. Of cases with LM, 93.5% (72 of 77) were PRAME+ and 94.7% (18 of 19) of cases with no residual LM were PRAME- . Of the 35 cases with no margin involvement by PRAME or conventional assessment, 14 cases (40.0%) had no difference in measurement, 17 (48.6%) had a difference of 1 mm or less and four (11.4%) differed by between 1 and 3.5 mm. There was a high correlation between margin assessment methods (r = 0.97, P < 0.0001). CONCLUSIONS PRAME IHC is a sensitive (93.5%) and specific (94.7%) method for diagnosing LM on biopsy and excision, and measurement of histological margins by PRAME shows a high correlation with conventional methods for margin assessment. Furthermore, the nuclear expression of PRAME makes it a good target for use in dual-colour IHC stains.
Collapse
Affiliation(s)
- Sarah E Gradecki
- Department of Pathology, University of Virginia, Charlottesville, VA, USA
| | | | - Mark R Wick
- Department of Pathology, University of Virginia, Charlottesville, VA, USA
| | - Alejandro A Gru
- Department of Pathology, University of Virginia, Charlottesville, VA, USA
| |
Collapse
|
10
|
Navarrete-Dechent C, Aleissa S, Connolly K, Hibler BP, Dusza SW, Rossi AM, Lee E, Nehal KS. Clinical size is a poor predictor of invasion in melanoma of the lentigo maligna type. J Am Acad Dermatol 2020; 84:1295-1301. [PMID: 33096134 DOI: 10.1016/j.jaad.2020.10.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 09/28/2020] [Accepted: 10/15/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND There are no well-defined clinical factors to predict the risk of occult invasion in melanoma of the lentigo maligna type (LM) before complete histopathologic analysis. OBJECTIVE To evaluate whether clinical size was a predictor of invasion in LM and subclinical extension. METHODS Consecutive cases of LM were recorded in a prospectively maintained database from 2006 to 2019. Patient and tumor data were recorded during initial evaluation. The LM clinical area was calculated in square millimeters (length × width). All patients were treated with staged excision. RESULTS We included 600 patients. The mean age was 65.9 years (standard deviation, 12.3; range, 27-95 years); 62.8% (n = 377) were men. The mean LM clinical area was 128.32 mm2 for in situ lesions versus 200.14 mm for invasive lesions (P = .1). Based on quantile regression, the median margin required for complete removal increased with LM clinical area. LIMITATIONS The study was performed in a tertiary cancer center with possible referral bias and more complex cases. CONCLUSIONS LM can present with variable clinical size, which may correlate with subclinical extension; however, the presence of invasion is not well estimated by LM clinical area.
Collapse
Affiliation(s)
- Cristian Navarrete-Dechent
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Dermatology, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Saud Aleissa
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Karen Connolly
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Brian P Hibler
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephen W Dusza
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anthony M Rossi
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Erica Lee
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kishwer S Nehal
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York.
| |
Collapse
|
11
|
Tio D, Willemsen M, Krebbers G, Kasiem FR, Hoekzema R, van Doorn R, Bekkenk MW, Luiten RM. Differential Expression of Cancer Testis Antigens on Lentigo Maligna and Lentigo Maligna Melanoma. Am J Dermatopathol 2020; 42:625-627. [PMID: 32701706 DOI: 10.1097/dad.0000000000001607] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The cancer/testis antigens (CTA) are a group of antigens expressed on germ cells of healthy testis and malignant tumors. We studied whether CTA are present on lentigo maligna (LM) and LM melanoma (LMM) samples. Immunohistochemical expression of a panel of CTA (MAGE-A1, A2- A3, NY-ESO-1, PRAME, SSX-2, and a MAGE-A antibody reactive with -A1, -A2, -A3, -A4, -A6, -A10, and -A12) was investigated in formalin-fixed paraffin-embedded samples from LMM (n = 20), LM (n = 8), chronically sun-exposed skin (n = 7), and healthy skin (n = 7). In 4 LMM lesions, the MAGE-A marker was positive. Another 3 LMM lesions were positive for MAGE-A1, MAGE-A2, and MAGE-A3. PRAME was positive in 18/20 LMM and 6/8 LM. We did not find expression of MAGE, NY-ESO-1, or SSX-2 in LM, thereby excluding these CTA as diagnostic markers to discern malignant melanocytes in LM from normal melanocytes. LMM did express MAGE, NY-ESO-1, and SSX-2. If a biopsy from a lesion suspect for LM shows positivity for MAGE, NY-ESO-1, and SSX-2, the lesion may actually be LMM. In contrast, PRAME expression was found in LM at low levels and in LMM at much higher levels, and absent in normal melanocytes. PRAME can potentially be used to discern normal melanocytes from malignant melanocytes.
Collapse
Affiliation(s)
- Darryl Tio
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam UMC, Amsterdam Infection & Immunity Institute, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, the Netherlands; and
| | - Marcella Willemsen
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam UMC, Amsterdam Infection & Immunity Institute, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, the Netherlands; and
| | - Gabrielle Krebbers
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam UMC, Amsterdam Infection & Immunity Institute, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, the Netherlands; and
| | - Fazira R Kasiem
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam UMC, Amsterdam Infection & Immunity Institute, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, the Netherlands; and
| | - Rick Hoekzema
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam UMC, Amsterdam Infection & Immunity Institute, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, the Netherlands; and
| | - Remco van Doorn
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Marcel W Bekkenk
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam UMC, Amsterdam Infection & Immunity Institute, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, the Netherlands; and
| | - Rosalie M Luiten
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam UMC, Amsterdam Infection & Immunity Institute, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, the Netherlands; and
| |
Collapse
|
12
|
Peruilh-Bagolini L, Apalla Z, González-Cuevas R, Lallas K, Papageorgiou C, Bobos M, Manoli SM, Gkentsidi T, Spyridis I, Lazaridou E, Sotiriou E, Vakirlis E, Ioannides D, Lallas A. Dermoscopic predictors to discriminate between in situ and early invasive lentigo maligna melanoma: A retrospective observational study. J Am Acad Dermatol 2020; 83:269-271. [PMID: 32199898 DOI: 10.1016/j.jaad.2020.03.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/07/2020] [Accepted: 03/10/2020] [Indexed: 11/19/2022]
Affiliation(s)
| | - Zoe Apalla
- State Clinic of Dermatology, Hippokration General Hospital, Thessaloniki, Greece
| | | | | | | | - Mattheos Bobos
- Microdiagnostics Pathology Laboratory, Thessaloniki, Greece
| | | | | | - Ioannis Spyridis
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Elizabeth Lazaridou
- Second Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Elena Sotiriou
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | | | | | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| |
Collapse
|
13
|
Rastoder E, Glud M. [Diagnostics and treatment of lentigo maligna melanoma in Denmark]. Ugeskr Laeger 2019; 181:V08180544. [PMID: 31791471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The incidence of maligna melanoma has doubled in Denmark over the latest 30 years. Lentigo maligna melanomas (LMM) account for 10-26% of the melanomas in head and neck. LMM most often strike people over the age of 70 years and frequently occur in sun-exposed skin areas. LMM can be difficult to diagnose, since its clinical features are similar to benign skin lesions, solar lentigo and seborrhoeic keratosis. This review presents various methods for diagnosing and treating LMM. The specific method is chosen in dialogue with the patients, and overall health is an important factor when choosing an appropriate treatment.
Collapse
|
14
|
Ozbagcivan O, Akarsu S, Ikiz N, Semiz F, Fetil E. Dermoscopic Differentiation of Facial Lentigo Maligna from Pigmented Actinic Keratosis and Solar Lentigines. Acta Dermatovenerol Croat 2019; 27:146-152. [PMID: 31542057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The differential diagnosis of lentigo maligna (LM) from pigmented actinic keratosis (PAK) and solar lentigines (SL) remains a challenge for clinicians, especially in the early stages of LM when there are no distinctive dermoscopic features. Objective of this study was to evaluate the frequencies of selective dermoscopic criteria in LM, PAK, and SL and to find the specific combination of distinguishing dermoscopic criteria for LM. Dermoscopists blinded to histopathological diagnosis evaluated 42 LM, 107 PAK, and 16 SL for the presence of predefined dermoscopic criteria. The differences in the presence of dermoscopic criteria between LM and others were evaluated with the chi-squared test or Fisher's exact test as appropriate. Multivariate logistic regression analysis with the forward conditional stepwise method were performed and odds ratios and corresponding 95% confidence intervals for LM, PAK, and SL were calculated. LM, PAK, and SL showed many common dermoscopic findings. In multivariate logistic regression analysis, darkening at dermoscopic examination (sevenfold), gray circles (sevenfold), target-like pattern (sixfold), gray rhomboids (sixfold), and slate-gray dots/globules (threefold) represented the strongest predictors of LM, while hyperkeratosis (thirteenfold), white circles (twelvefold), and red rhomboids (sixfold) represented the strongest predictors of PAK. The dermoscopic diagnosis of a given lesion should be based on the presence of the combination of specific dermoscopic criteria rather than a single benign or malignant criterion. Our results suggest that the presence of darkening at dermoscopic examination, gray circles, target-like pattern, gray rhomboids, and slate-gray dots/globules should be considered supportive findings for the diagnosis of early LM.
Collapse
Affiliation(s)
- Ozlem Ozbagcivan
- Ozlem Ozbagcivan, MD, Dokuz Eylul University, Faculty of Medicine, Department of Dermatology, 35340 Inciralti, Izmir, Turkey;
| | | | | | | | | |
Collapse
|
15
|
Moreno A, Manrique-Silva E, Virós A, Requena C, Sanmartín O, Traves V, Nagore E. Histologic Features Associated With an Invasive Component in Lentigo Maligna Lesions. JAMA Dermatol 2019; 155:782-788. [PMID: 31066867 PMCID: PMC6506897 DOI: 10.1001/jamadermatol.2019.0467] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 02/21/2019] [Indexed: 11/14/2022]
Abstract
Importance Lentigo maligna (LM) presents an invasive component in up to 20% of biopsied cases, but to date the histologic features useful in detecting this invasive component have not been described. Some histologic characteristics are hypothesized to contribute to the progression of LM invasion. Objective To identify the histologic characteristics associated with lentigo maligna melanoma (LMM) in patients with LM diagnosed by a partial diagnostic biopsy. Design, Setting, and Participants A retrospective cross-sectional study of patients treated between January 1, 2000, and December 31, 2017, was conducted in a referral oncology center in València, Spain. Data and specimens of patients (n = 96) with a diagnosis of primary cutaneous melanoma in the form of either LM or LMM who had undergone surgical treatment, a complete histologic examination of the whole tumor, and an initial diagnostic partial biopsy of LM were included in the study. Histologic assessment was blinded to the presence of an invasive component. Interventions All biopsy specimens were evaluated for the presence of certain histologic characteristics. Main Outcomes and Measures Comparisons between invasive samples and samples without an invasive component were performed. The differences in the distribution of variables between the groups were assessed using the χ2 and Fisher exact tests, and the degree of association of the relevant variables was quantified by logistic regression models. A classification and regression tree analysis was performed to rank the variables by importance. Results In total, 96 patients had sufficient histologic material that could be evaluated. The patients were predominantly male (56 [58.3%]) and had a mean (SD) age at diagnosis of 72 (12) years. Of these patients, 63 (65.6%) had an LM diagnosis and 33 (34.4%) had an LMM diagnosis (an invasive component). The histologic variables associated with the presence of an invasive component were melanocytes forming rows (odds ratio [OR], 11.5; 95% CI, 1.4-94.1; P = .02), subepidermal clefts (OR, 2.8; 95% CI, 1.0-7.9; P = .049), nests (OR, 3.0; 95% CI, 1.1-8.6; P = .04), and a lesser degree of solar elastosis (OR, 0.4; 95% CI, 0.1-1.1; P = .07). A classification and regression tree analysis of the relevant histologic features was able to accurately identify lentigo maligna with an invasive component (LMM) in more than 60% of patients. Conclusions and Relevance These findings may be useful in classifying early LM specimens at higher risk of invasion, which may eventually be relevant in identifying the most appropriate management for LM.
Collapse
Affiliation(s)
- Angela Moreno
- School of Medicine, Universidad Católica de Valencia San Vicente Mártir, València, Spain
| | - Esperanza Manrique-Silva
- Department of Dermatology, Instituto Valenciano de Oncología, València, Spain
- Escuela de Doctorado, Universidad Católica de Valencia San Vicente Mártir, València, Spain
| | - Amaya Virós
- Skin Cancer and Ageing Laboratory, CRUK Manchester Institute, The University of Manchester, Manchester, United Kingdom
| | - Celia Requena
- Department of Dermatology, Instituto Valenciano de Oncología, València, Spain
| | - Onofre Sanmartín
- Department of Dermatology, Instituto Valenciano de Oncología, València, Spain
| | - Víctor Traves
- Department of Pathology, Instituto Valenciano de Oncología, València, Spain
| | - Eduardo Nagore
- School of Medicine, Universidad Católica de Valencia San Vicente Mártir, València, Spain
- Department of Dermatology, Instituto Valenciano de Oncología, València, Spain
| |
Collapse
|
16
|
Aouidad I, Fargeas C, Romero P, Sei JF, Chaussade V, Beauchet A, Clerici T, Zimmermann U, Saiag P, Funck-Brentano E. Histologic predictors of invasion in partially biopsied lentigo maligna melanoma. J Am Acad Dermatol 2018; 80:1150-1152. [PMID: 30879481 DOI: 10.1016/j.jaad.2018.10.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 10/18/2018] [Accepted: 10/22/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Iman Aouidad
- Research Unit EA 4340 Biomarkers in Cancerology and in Hemato-oncology, University of Versailles-Saint-Quentin-en-Yvelines, Université Paris-Saclay, Boulogne-Billancourt, France; Department of Dermatology, Ambroise Paré Hospital, Boulogne-Billancourt, France.
| | - Céline Fargeas
- Department of Pathology, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - Pierre Romero
- Research Unit EA 4340 Biomarkers in Cancerology and in Hemato-oncology, University of Versailles-Saint-Quentin-en-Yvelines, Université Paris-Saclay, Boulogne-Billancourt, France; Department of Pathology, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - Jean-François Sei
- Department of Dermatology, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - Véronique Chaussade
- Department of Dermatology, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - Alain Beauchet
- Department of Public Health, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - Thierry Clerici
- Department of Pathology, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - Ute Zimmermann
- Department of Pathology, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - Philippe Saiag
- Research Unit EA 4340 Biomarkers in Cancerology and in Hemato-oncology, University of Versailles-Saint-Quentin-en-Yvelines, Université Paris-Saclay, Boulogne-Billancourt, France; Department of Dermatology, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - Elisa Funck-Brentano
- Research Unit EA 4340 Biomarkers in Cancerology and in Hemato-oncology, University of Versailles-Saint-Quentin-en-Yvelines, Université Paris-Saclay, Boulogne-Billancourt, France; Department of Dermatology, Ambroise Paré Hospital, Boulogne-Billancourt, France
| |
Collapse
|
17
|
Witta S, Bershow A, Farah RS, Berg B, Goldfarb N. Dermoscopy findings of a one mm lentigo maligna. Dermatol Online J 2018; 24:13030/qt5xp740wn. [PMID: 30261577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 09/12/2018] [Indexed: 06/08/2023] Open
Abstract
A 66-year-old man presented with a grayish 1mm macule on the left cheek. Dermatoscopic examination revealed annular-granular structures partially surrounding a single follicular ostium. Histopathologic examination demonstrated atypical, confluent single melanocytes at the basal layer with nesting, crowding, and upward migration descending along the hair follicle, consistent with the diagnosis of lentigo maligna (LM). This case presents evidence in support of the Schiffner progression model for LMs, starting with asymmetric pigmented follicular openings composed of annular-granular structures, which later coalesce into gray to dark black/brown streaks, and then form pseudo-networks or rhomboidal structures. The finding of annular-granular structures partially surrounding a single hair follicle may be the earliest recognizable dermatoscopic feature of an LM and may help clinicians diagnose facial LMs earlier.
Collapse
Affiliation(s)
| | | | | | | | - Noah Goldfarb
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota Department of Dermatology, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota Department of Medicine, University of Minnesota, Minneapolis, Minnesota Department of Medicine, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota.
| |
Collapse
|
18
|
Bono A, Bartoli C, Tessandri L, Del Prato I, Tragni G, Bucci A, Moglia D, Cascinelli N. In Situ and Very thin Melanomas (< 0.75 mm) are Similarly and Commonly Recognizable. Tumori 2018; 82:600-2. [PMID: 9061073 DOI: 10.1177/030089169608200618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and Background Recent data have suggested that cutaneous melanoma in situ can be clinically recognized in most cases by its features, which resemble those of early invasive melanoma. The aim of the study was to verify whether the diagnostic sensitivity of melanoma in situ is actually equivalent to that of early invasive melanoma. Methods We retrospectively reviewed the clinical diagnosis of 274 consecutive cutaneous melanoma <0.75 mm thick. The series consisted of 84 in situ and 190 invasive lesions. Results The clinical diagnosis of melanoma was performed in 62% (52/84) of cases of in situ melanoma and in 68% (130/190) of the cases of invasive melanoma. The differences were not statistically significant. Conclusions Our results show that cutaneous melanoma can be clinically diagnosed at a very early stage. In situ and very thin melanomas (< 0.75 mm) are similarly recognizable.
Collapse
Affiliation(s)
- A Bono
- Division of Surgical Semeiotics & Ambulatory Surgery, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Neittaanmäki-Perttu N, Grönroos M, Jeskanen L, Pölönen I, Ranki A, Saksela O, Snellman E. Delineating margins of lentigo maligna using a hyperspectral imaging system. Acta Derm Venereol 2015; 95:549-52. [PMID: 25394551 DOI: 10.2340/00015555-2010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Lentigo maligna (LM) is an in situ form of melanoma which can progress into invasive lentigo maligna melanoma (LMM). Variations in the pigmentation and thus visibility of the tumour make assessment of lesion borders challenging. We tested hyperspectral imaging system (HIS) in in vivo preoperative delineation of LM and LMM margins. We compared lesion margins delineated by HIS with those estimated clinically, and confirmed histologically. A total of 14 LMs and 5 LMMs in 19 patients were included. HIS analysis matched the histo-pathological analysis in 18/19 (94.7%) cases while in 1/19 (5.3%) cases HIS showed lesion extension not confirmed by histopathology (false positives). Compared to clinical examination, HIS defined lesion borders more accurately in 10/19 (52.6%) of cases (wider, n = 7 or smaller, n = 3) while in 8/19 (42.1%) cases lesion borders were the same as delineated clinically as confirmed histologically. Thus, HIS is useful for the detection of subclinical LM/LMM borders.
Collapse
Affiliation(s)
- Noora Neittaanmäki-Perttu
- Department of Dermatology and Allergology, Helsinki University Central Hospital, FIN-00029 Helsinki, Finland.
| | | | | | | | | | | | | |
Collapse
|
20
|
Gottvaldová M, Jedličková H, Poprach A, Vašků V. [A Case of Delayed Dia-gnosis of Acral Lentiginous Melanoma]. Klin Onkol 2015; 28:439-443. [PMID: 26673994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Melanoma is a malignant skin disease. The tumor development is caused by an uncontrollable proliferation of melanocytes. The most common occurrence is on the skin, but melanoma may also develop on the mucous membrane, meninges, and eyes. Some melanomas develop from melanocytic nevus. Acral lentiginous melanoma occurs on palms, feet, fingers and under nails, and is the most common type of melanoma for phototype VI. The most important factor for successful treatment of malignant melanoma is an early detection, excision of the primary tumor and histological staging. Surgical treatment of an early-stage melanoma is a key to successful therapy; however, many patients (mostly men) do not seek medical attention before it istoo late. CASE REPORT This case study presents a 59-year-old patient, who suffers from white coat syndrome and whose finger was amputated for alleged gangrene. Subsequently, brownish black nodules appeared across his arm. Histological examination proved metastases of malignant melanoma. It was only at this phase, when the patient admitted a nevus at the tip of his amputated finger, from which ulceration and gangrene gradually emerged. CONCLUSION This case demonstrates a combination of multiple unfavorable factors, which led to delayed diagnosis and therapy.
Collapse
|
21
|
Alcalay J. [Lentigo maligna: a diagnostic and therapeutic challenge]. Harefuah 2014; 153:259-305. [PMID: 25112116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Lentigo maligna is an early type of melanoma which appears in sun damaged skin. The clinical diagnosis as well as the pathological diagnosis are a challenge to the clinician and the pathologist since atypical proliferation of melanocytes is a common finding in chronically sun exposed skin. The use of a dermatoscope and in vivo reflectance confocal microscopy as diagnostics aids can make the clinical diagnosis more accurate. Mohs micrographic surgery has become the standard of care, if available, for lentigo maligna.
Collapse
|
22
|
Scope A, Barzilai A, Zilinsky I. [Clinical utility of reflectance confocal microscopy for the non-invasive diagnosis of lentigo maligna melanoma]. Harefuah 2014; 153:248-306. [PMID: 25112112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Lentigo maligna melanoma (LMM), a melanoma subtype that arises on sun-damaged facial skin, is difficult to diagnose clinically. Patients and physicians are reluctant to perform unnecessary facial biopsies. Reflectance confocal microscopy (RCM) is a novel technique for non-invasive skin imaging at cellular-level resolution. RCM increases the accuracy of melanoma diagnosis. AIMS To describe the diagnostic utility of RCM in cases of clinically and dermatoscopically equivocal pigmented skin lesions suspicious for LMM. METHODS This is a retrospective case series derived from the population of patients undergoing periodic skin cancer screening at a tertiary hospital clinic that specializes in skin cancer diagnosis. All patients consented to RCM imaging as an ancillary test prior to the decision on performing a biopsy in the facial lesion. RESULTS We report on four patients who presented clinically and dermatoscopically equivocal pigmented skin lesions in the head and neck region, with differential diagnosis of LMM. Furthermore, in two patients, a prior incisional biopsy indicated a benign diagnosis upon histopathological analysis. In all cases, RCM examination showed specific criteria for LMM. The RCM diagnosis of LMM allowed direct referral for excisional surgery in three patients. In another patient, RCM findings guided incisional biopsy-site selection to a focus that revealed histopathology clear-cut criteria for LMM. CONCLUSIONS RCM is a very useful adjunct to the non-invasive diagnosis of LMM.
Collapse
|
23
|
Mirzoyev SA, Knudson RM, Reed KB, Hou JL, Lohse CM, Frohm ML, Brewer JD, Otley CC, Roenigk RK. Incidence of lentigo maligna in Olmsted County, Minnesota, 1970 to 2007. J Am Acad Dermatol 2014; 70:443-8. [PMID: 24373777 PMCID: PMC4527652 DOI: 10.1016/j.jaad.2013.11.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 10/16/2013] [Accepted: 11/04/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND The incidence of lentigo maligna (LM) may be increasing, but no population-based epidemiologic studies have been performed to our knowledge. OBJECTIVE We sought to determine the incidence of LM in Olmsted County, Minnesota, along with overall and recurrence-free survival. METHODS Using the Rochester Epidemiology Project, we identified all adult residents of Olmsted County, Minnesota, with a first lifetime diagnosis of LM between 1970 and 2007. Medical records were reviewed to determine demographic, clinical, and surgical data, and incidence and survival were calculated. RESULTS Among 145 patients identified, median (range) age at diagnosis of LM was 70 (33-97) years. Treatment changed over time, with Mohs micrographic surgery becoming available after 1986. No patients died of LM; 5 had local recurrence. Estimated local recurrence-free survival at 5, 10, 15, and 20 years after diagnosis was 98%, 96%, 92%, and 92%, respectively. Overall age- and sex-adjusted incidence of LM among adults was 6.3 per 100,000 person-years, increasing from 2.2 between 1970 and 1989 to 13.7 between 2004 and 2007. LIMITATIONS Retrospective study design and homogeneous population are limitations. CONCLUSION The incidence of LM increased significantly among residents of Olmsted County, Minnesota, over an extended time frame, with incidence being significantly higher among men than women and increasing with age.
Collapse
Affiliation(s)
- Sultan A Mirzoyev
- Mayo Medical School, Mayo Clinic College of Medicine, Rochester, Minnesota
| | | | - Kurtis B Reed
- Division of Dermatologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jennifer L Hou
- Mayo Medical School, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Christine M Lohse
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Marcus L Frohm
- Division of Dermatologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jerry D Brewer
- Division of Dermatologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Clark C Otley
- Division of Dermatologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Randall K Roenigk
- Division of Dermatologic Surgery, Mayo Clinic, Rochester, Minnesota.
| |
Collapse
|
24
|
Situm M, Buljan M, Kolić M, Vučić M. Melanoma--clinical, dermatoscopical, and histopathological morphological characteristics. Acta Dermatovenerol Croat 2014; 22:1-12. [PMID: 24813835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Melanoma is one of the most malignant skin tumors with constantly rising incidence worldwide, especially in fair-skinned populations. Melanoma is usually diagnosed at the average age 50, but, nowadays is also diagnosed more frequently in younger adults, and very rarely in childhood. There is no unique or specific clinical presentation of a melanoma. The clinical presentation of melanomas varies depending on the anatomic localization and the type of growth, i.e., the histopathological type of the cancer. There are four major histopathological types of melanoma--superficial spreading melanoma, nodular melanoma, lentigo maligna melanoma, and acral lentiginous melanoma. Although dermatoscopy is a very useful tool in early melanoma detection, dermatoscopical features of melanomas are also variable. Therefore, experience and education in dermatoscopy is crucial in the evaluation of skin tumors. Differential diagnosis of melanomas includes a wide range of benign and malignant skin lesions, due to their clinical presentation and resemblance to various dermatological entities. In this review we present the most important aspects of clinical, dermatoscopical, and histopathological features of melanomas.
Collapse
Affiliation(s)
| | - Marija Buljan
- Marija Buljan, MD, PhD, Department of Dermatovenereology , Sestre milosrdnice University Hospital Centre , Vinogradska cesta 29 , 10 000 Zagreb, Croatia;
| | | | | |
Collapse
|
25
|
Edwards SP, Chamberlain AJ. Photographic artefact simulating regressing melanocytic lesion: a potential pitfall of total body photography. Australas J Dermatol 2012; 53:314-5. [PMID: 23157784 DOI: 10.1111/j.1440-0960.2012.00913.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
26
|
Abstract
Solar lentigines are considered one of the earliest signs of photoaging and are an extremely common cosmetic complaint. Successful removal of these lesions can be achieved with laser and non-laser light sources, and is one of the most frequently performed cosmetic procedures in laser centers. Distinguishing a benign lentigo from other pigmented lesions can sometimes be challenging, even for a trained dermatologist. We report a series of three patients who presented to our laser center within 2 months of one another for cosmetic removal of pigmented lesions that were found to be melanoma. One patient was referred by another dermatologist, one by a physician family member, and the other presented on his own. These cases highlight the need for careful evaluation of pigmented lesions prior to laser treatment, regardless of the source of the referral. In this article, we will review the diagnostic and treatment differences between lentigines and their malignant counterparts, and examine the role of laser in both.
Collapse
Affiliation(s)
- Kelly Stankiewicz
- Dermatology Laser and Cosmetic Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA
| | | | | |
Collapse
|
27
|
van der Waal RIF. [Lentigo maligna]. Ned Tijdschr Tandheelkd 2011; 118:531. [PMID: 22235514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|
28
|
van der Waal RIF. [Lentigo maligna]. Ned Tijdschr Tandheelkd 2011; 118:531. [PMID: 22235513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|
29
|
Affiliation(s)
- Aylin Türel Ermertcan
- Department of Dermatology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey.
| | | | | | | | | | | |
Collapse
|
30
|
Situm M, Bolanca Z, Buljan M. Lentigo maligna melanoma--the review. Coll Antropol 2010; 34 Suppl 2:299-301. [PMID: 21305747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Lentigo maligna melanoma (LMM) is a slowly growing tumor of elderly white population. It typically develops on chronically sun-exposed skin of the head and neck area which indicates that the cumulative exposure to the UV radiation has crucial role in the development of LMM. Precursor lesion is lentigo maligna (LM) which commonly presents as an irregular brownish pigmented macular lesion persisting for years. Women are affected more often as men by LMM, with the average age of over 60 years. The age of onset has dropped over the past years and this tumour is nowadays also diagnosed in 40-year-old individuals. However, the incidence rate increases with age and peaks in the seventh and eighth decades of life. The prognosis for invasive lentigo maligna melanoma does not differ from that for other histogenetic types of melanoma after controlling for tumour thickness. The diagnosis and treatment of LMM remain challenging. In this presentation, we review the epidemiology, clinical presentation, histopathology, and treatment of LMM.
Collapse
Affiliation(s)
- Mirna Situm
- University Department of Dermatovenerology, University Hospital Sestre milosrdnice, Zagreb, Croatia
| | | | | |
Collapse
|
31
|
Walling HW. Lentigo maligna: current concepts in diagnosis and management. GIORN ITAL DERMAT V 2009; 144:149-155. [PMID: 19357622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Lentigo maligna (LM) is a cutaneous malignancy with increasing incidence and significant risk of morbidity. Early diagnosis of LM requires a high index of suspicion for the often subtle atypical signs of pigmented lesions on sun-damaged skin. A variety of treatment options are available to the physician. Surgical options include simple excision and margin-control techniques such as staged excision and Mohs micrographic surgery. Tissue may be embedded vertically or en face, and processed as frozen or paraffin-embedded sections. Destructive options include radiotherapy, cryotherapy, curettage, and electro-destruction. Topical therapy may be appropriate in selected cases; immunotherapy with topical imiquimod may have advantages over other topical agents. The opportunity for curative therapy is maximized by surgical treatment. Margin-control surgery offers the highest cure rate while minimizing loss of normal tissue.
Collapse
Affiliation(s)
- H W Walling
- Town Square Dermatology, Coralville, IA 52246, USA.
| |
Collapse
|
32
|
Abstract
Recent advances in translational research in and technology for confocal microscopy of skin cancers, toward clinical applications, are described. Advances in translational research are in diagnosis of melanoma in vivo, pre-operative mapping of lentigo maligna melanoma margins to guide surgery and intra-operative imaging of residual basal cell carcinomas to guide shave-biopsy. Advances in technology include mosaicing microscopy for detection of basal cell carcinomas in large areas of excised tissue, toward rapid pathology-at-the-bedside, and development of small, simple and low-cost line-scanning confocal microscopes for worldwide use in diverse primary healthcare settings. Current limitations and future opportunities and challenges for both clinicians and technologists are discussed.
Collapse
Affiliation(s)
- Milind Rajadhyaksha
- Dermatology Service, Memorial Sloan-Kettering Cancer Center, 160 East 53 Street, New York, NY 10022, USA.
| |
Collapse
|
33
|
Levine N. Slowly enlarging, pigmented lesion on temple. Geriatrics (Basel) 2008; 63:27. [PMID: 19061276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
|
34
|
Ikoma N, Umezawa Y, Mabuchi T, Tamiya S, Matsuyama T, Ozawa A. Lentigo maligna occurring in a patient with the past history of laser therapy. Tokai J Exp Clin Med 2008; 33:75-77. [PMID: 21318971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Accepted: 03/17/2008] [Indexed: 05/30/2023]
Abstract
A 70-year-old Japanese woman visited our clinic with a pigmented patch on her face from her upper lip to under her nose following laser therapy 15 years ago. Physical examination revealed an asymmetrical dark brown macule with a clear border along with irregular black dots measuring 20 mm. A biopsy specimen showed some irregular-sized atypical melanocytes with deep-colored nuclei on staining. There were observed on the basal layer and a few of them in the prickle-cell layer only in the epidermis. We diagnosed this case as lentigo maligna (LM). Total resection and reconstruction with the Abbe flap were carried out. We searched previous literature for reports on laser therapies resulting in LM and determined the following: (1) there were no reports indicating that laser therapy is one of the causes of LM, (2) judging from invalidity of treatment or recurrence of the condition, laser therapies were considered ineffective for LM treatment, and (3) the numbers of patients undergoing laser therapies, who were not diagnosed with LM, were increasing.
Collapse
Affiliation(s)
- Norihiro Ikoma
- Department of Dermatology, Tokai University School of Medicine, Shimokasuya 143, Isehara, Kanagawa, Japan.
| | | | | | | | | | | |
Collapse
|
35
|
Calista D, Riccioni L. A brownish macule on the tip of the nose. J Eur Acad Dermatol Venereol 2008; 21:1281-2. [PMID: 17894737 DOI: 10.1111/j.1468-3083.2007.02177.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
36
|
Affiliation(s)
- Alejandra M Abeldaño
- Department of Dermatology, Hospital General de Agudos Dr. Cosme Argerich, University of Buenos Aires School of Medicine, Buenos Aires, Argentina.
| | | | | | | | | |
Collapse
|
37
|
van Meurs T, van Doorn R, Kirtschig G. Recurrence of Lentigo Maligna after Initial Complete Response to Treatment with 5% Imiquimod Cream. Dermatol Surg 2007; 33:623-6; discussion 626-7. [PMID: 17451589 DOI: 10.1111/j.1524-4725.2007.33129.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- T van Meurs
- Department of Dermatology, VU University Medical Center, 1007 MB Amsterdam, The Netherlands.
| | | | | |
Collapse
|
38
|
Levine N. Asymptomatic pigmented lesion on left ear. Geriatrics (Basel) 2007; 62:26. [PMID: 17408316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
|
39
|
Levine N. Flat, asymmetrical pigmented patch on back: patient reports substantial sun exposure. Geriatrics (Basel) 2006; 61:14. [PMID: 16901192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Affiliation(s)
- Norman Levine
- University of Arizona Health Sciences Center, Tucson, AZ, USA
| |
Collapse
|
40
|
Abstract
BACKGROUND Lentigo maligna (LM) is a subtype of melanoma in situ that typically develops on sun-damaged skin. Presentation may be quite subtle and delayed diagnosis is common. Clinical margins are often ill defined. Histologic evaluation can be difficult due to the widespread atypical melanocytes that are present in the background of long-standing sun damage. Recurrence following standard therapies is common. OBJECTIVE To review the clinical features, histopathology, and treatment options for LM. Emphasis is placed on recent advances in the treatment of LM. METHODS AND MATERIALS Literature review. RESULTS The estimated lifetime risk of LM progressing to LM melanoma is 5%. Standard excision of LM with 5 mm margins is insufficient in 50% of cases. The recurrence rate with standard excision ranges from 8 to 20%. Mohs surgery and staged excision may offer better margin control and lower recurrence rates (4-5%). Estimates of recurrence rates following nonsurgical therapies such as cryosurgery, radiotherapy, electrodessication and curettage, laser surgery, and topical medications range from 20 to 100% at 5 years. CONCLUSIONS Adequate treatment of LM requires a comprehensive knowledge of the diagnostic features, histopathology, and treatment options. Surgical modalities with meticulous evaluation of tissue margins appears to offer the lowest rates of disease recurrence.
Collapse
Affiliation(s)
- Jeffrey K McKenna
- Division of Dermatology, University of Vermont College of Medicine, Burlington, Vermont 05401, USA.
| | | | | | | |
Collapse
|
41
|
Abstract
BACKGROUND Determining the best biopsy technique for a suspected lentigo maligna can be challenging. Because complete excisional biopsy is rarely practical, the physician is left to choose an appropriate area to biopsy. Sampling error can have devastating consequences, especially if the biopsy demonstrates a pigmented lesion that was considered in the clinical differential diagnosis. The presence of a solar lentigo, pigmented actinic keratosis, or reticulated seborrheic keratosis could mislead the pathologist and clinician to the erroneous conclusion that the incisional specimen is representative of the whole, and that no lentigo maligna is present. OBJECTIVE We have often observed the presence of a contiguous pigmented lesion adjacent to lentigo maligna. The current study was designed to determine how frequently this phenomenon occurs. METHODS We studied Mohs debulking specimens of lentigo maligna, and broad shave biopsy specimens of pigmented lesions on heavily sun-damaged areas of the skin proven to be lentigo maligna. RESULTS Contiguous pigmented lesions were present in 48% of the specimens. The most common lesion was a benign solar lentigo (30%), followed by pigmented actinic keratosis (24%). CONCLUSION Recognition of this phenomenon may prevent misdiagnosis of lentigo maligna related to sampling error.
Collapse
Affiliation(s)
- Scott R Dalton
- Department of Pathology, Bassett Army Hospital, Ft. Wainwright, Alaska, USA
| | | | | | | |
Collapse
|
42
|
|
43
|
|
44
|
Abstract
Atypical lentiginous melanocytic proliferations in elderly patients continue to pose a diagnostic dilemma with lesions variably categorized as dysplastic nevus, atypical junctional nevus, melanoma in situ (early or evolving) and premalignant melanosis. We present pigmented lesions from 16 patients (seven male and nine female) and with the exception of one case, all were older than 50 years of age. The anatomical sites included trunk (7), head and neck (6) and upper extremity (3). The clinical diagnosis was variable and included lentigo maligna, atypical nevus, pigmented basal cell carcinoma, seborrheic keratosis and lentigo. The initial biopsies mimicked lentiginous nevus or dysplastic nevus and were characterized by a lentiginous proliferation of melanocytes at the dermoepidermal junction both as single cells and as small nests with areas of confluent growth, extending to the edges of the biopsy. The retiform epidermis was maintained and pagetoid spread of melanocytes was not prominent in hematoxylin- and eosin- stained sections. Dermal fibrosis was variably present and the melanocytic proliferation demonstrated cytological atypia. The subsequent re-excisions demonstrated similar atypical melanocytic proliferation occurring over a broad area flanking the prior biopsy sites. The diagnosis of melanoma was more easily recognized in the complete excision specimens. Immunohistochemical stains for Mitf and Mart-1 highlighted the extent of the basalar melanocytic proliferation as well as foci of pagetoid spread by melanocytes. Familiarity with this pattern of early melanoma should facilitate proper classification of lentiginous melanocytic proliferations in biopsies from older adults.
Collapse
Affiliation(s)
- Roy King
- Knoxville Dermatopathology Laboratory and Department of Pathology, University of Tennessee Graduate School of Medicine, Knoxville, TN 37919, USA.
| | | | | | | |
Collapse
|
45
|
Abstract
We demonstrate the utility of the Wood's light in a practice that specializes in the evaluation of pigmented lesions. The Wood's light assisted the physician in locating the site of a completely regressed primary cutaneous melanoma, determining the clinical borders of a lentigo maligna melanoma, differentiating between agminated naevi and a naevus spilus and detecting the recurrence of pigmentation after the excision of a dysplastic naevus, and also proved useful in monitoring a large segmental speckled atypical lentiginous naevus for change. Despite the availability of many 'high-tech' imaging and diagnostic devices designed to evaluate skin lesions, the relatively simple Wood's lamp continues to be of great value. We encourage physicians not to abandon the use of the Wood's light in their clinical practice.
Collapse
Affiliation(s)
- L-R Paraskevas
- Dermatology Division, Memorial Sloan-Kettering Skin Cancer Center at Suffolk, 800 Veterans Memorial Highway, Hauppauge, NY 11788, USA
| | | | | |
Collapse
|
46
|
Abstract
This article reviews the clinical characteristics, histology, biologic behavior, and recommended treatment for several benign and malignant lesions that may arise on the head and neck. Nevus sebaceus and congenital melanocytic nevus are two benign lesions that can present at a size of several centimeters. Surgical excision may be considered for cosmetic purposes and to reduce the small risk for the development of malignancy within each lesion. Basal and squamous cell carcinoma, lentigo maligna and lentigo maligna melanoma, dermatofibrosarcoma protuberans, and Merkel cell carcinoma are malignant lesions for which surgical excision is the recommended treatment. Local flap reconstruction may be used to address the surgical defects resulting from excision of these benign and malignant conditions.
Collapse
Affiliation(s)
- Julia K Padgett
- Department of Dermatology, University of Virginia, Primary Care Center, Third Floor, Lee Street, Charlottesville, VA 22908, USA.
| |
Collapse
|
47
|
Sahin MT, Oztürkcan S, Ermertcan AT, Güneş AT. A comparison of dermoscopic features among lentigo senilis/initial seborrheic keratosis, seborrheic keratosis, lentigo maligna and lentigo maligna melanoma on the face. J Dermatol 2005; 31:884-9. [PMID: 15729860 DOI: 10.1111/j.1346-8138.2004.tb00621.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Clinical differentiation of facial lentigo senilis/initial seborrheic keratosis (LS/ISK), seborrheic keratosis (SK), lentigo maligna (LM), and lentigo maligna melanoma (LMM) can be difficult. Dermoscopy improves the diagnoses in pigmented skin lesions (PSLs), but it is not helpful for the sun-exposed face because of the flat rete ridges without network-derived features. Therefore, development of new diagnostic criteria for this particular localization is a current issue of dermatology. In this retrospective study, dermoscopic slides of facial pigmented skin lesions of 66 patients referred to two clinics in Turkey were evaluated. Our aim was to determine the reliability of dermoscopy in the differentiation of these entities. The facial PSLs of 66 patients (34 males and 32 females) (median age: 58.2) were photographed with a Dermaphot (Heine, Hersching, Germany) over a five year period from November of 1995 to May of 2000. All of the dermoscopic slides were analysed according to 27 dermoscopic criteria developed by Schiffner et al. This data set contained 22 histologically proven malignant (14 LM, 8 early LMM) and 44 benign (18 SK, 26 LS/ISK) PSLs. In general, asymmetric pigmented follicular openings, dark streaks, slate-gray streaks, dark globules, slate-gray globules, dark dots, dark rhomboidal structures, light brown rhomboidal structures, dark homogeneous areas and dark pseudonetworks were statistically significant for malignant growth. On the other hand, milia-like cysts, pseudofollicular openings, cerebriform structures, light brown globules, light brown dots, light brown homogeneous areas, yellow opaque homogeneous areas, and light brown pseudonetworks were statistically significant for benign growth. This research emphasizes that dermoscopic features on the face differ from criteria used in other locations of the body. Analysis of the data suggests that dermoscopy can be used in the differentiation of LS/ISK, SK, LM and LMM from each other.
Collapse
Affiliation(s)
- Mustafa Turhan Sahin
- Department of Dermatology, Celal Bayar University, Medical Faculty, Manisa, Turkey
| | | | | | | |
Collapse
|
48
|
Abstract
Up until now, only lesions selected on the basis of their clinical atypia or which appear equivocal on naked eye examination have been shown to benefit from the use of dermoscopy. In our experience, dermoscopic evaluation of lesions located on the face may require a different approach, as a histopathological diagnosis of malignancy is not uncommon in clinically trivial lesions (i.e. lesions lacking the ABCD criteria for clinical suspicion). Moreover, at this site dermoscopy reveals specific criteria according to the particular histological architecture shown by sun-damaged skin. We report four cases of lentigo maligna (LM) of the face whose identification depended on dermoscopic examination which was performed routinely on all facial lesions, as the lesions did not show ABCD clinical criteria for malignancy. In our experience, the identification of early signs of malignancy by dermoscopy may indicate the excision of LM at an early phase, before the lesion is associated with the ABCD signs of melanoma. Dermatologists should avoid the mistake of immediately excluding a diagnosis of malignancy when examining an ABCD-negative pigmented skin lesion of the face.
Collapse
Affiliation(s)
- M Stante
- Department of Dermatology, University of Florence, Via Alfani 37, 50121 Florence, Italy.
| | | | | | | | | |
Collapse
|
49
|
Christenson LJ. Management of lentigo maligna. Dermatol Nurs 2004; 16:495-8, 505, 523. [PMID: 15690926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Lentigo maligna melanoma is a melanoma in situ on sun-damaged skin. It is a variably brown-pigmented flat patch on the head or neck of elderly patients. Its growth is generally slow, but it can become an invasive form of melanoma. Multiple reported treatment options are reviewed. Wide-margin Mohs micrographic surgery with peripheral permanent pathologic confirmation of a clear margin is recommended as treatment of choice.
Collapse
|
50
|
Price L. Lentigo maligna melanoma. Dermatol Nurs 2004; 16:454. [PMID: 15624713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
|