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Lentigo Maligna: Review of Salient Characteristics and Management

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Abstract

Lentigo maligna is a melanocytic neoplasm, often regarded as ‘melanoma in situ,’ which may progress to lentigo maligna melanoma. Lentigo maligna clinically presents as a pigmented, asymmetric macule that originates on the head and neck and spreads slowly. The preferred method for diagnosing lentigo maligna is excisional biopsy. Histology shows proliferation of atypical melanocytes at the epidermal–dermal junction in small nests or single cells. The differential diagnosis includes solar lentigo, seborrheic keratosis, lichen planus-like keratosis, pigmented actinic keratosis, and melanocytic nevus. Stains used in diagnosis include hematoxylin and eosin, HMB-45, MART-1/Melan-A, Mel-5, and S-100. Surgical excision is the preferred treatment for lentigo maligna. Second-line techniques include medical (topical imiquimod) and destructive therapy.

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References

  1. Cohen LM. Lentigo maligna and lentigo maligna melanoma. J Am Acad Dermatol. 1995;33(6):923–36 (quiz 937–40. Erratum in: J Am Acad Dermatol. 1997 Jun;36(6 Pt 1):913. PubMed PMID: 7490362).

    Google Scholar 

  2. Newell GR, Sider JG, Bergfelt L, Kripke ML. Incidence of cutaneous melanoma in the United States by histology with special reference to the face. Cancer Res. 1988;48(17):5036–41.

    PubMed  CAS  Google Scholar 

  3. Kuflik EG, Gage AA. Cryosurgery for lentigo maligna. J Am Acad Dermatol. 1994;31(1):75–8.

    Article  PubMed  CAS  Google Scholar 

  4. Dubreuilh MW. Lentigo malin des vieillards, Société de Dermatologie, 4 août, 1894.

  5. Smalberger GJ, Siegel DM, Khachemoune A. Lentigo maligna. Dermatol Ther. 2008;21(6):439–46 (PubMed PMID: 19076621). doi:10.1111/j.1529-8019.2008.00244.x.

  6. Al-Niaimi F, Jury CS, McLaughlin S, Herd RM. Review of management and outcome in 65 patients with lentigo maligna. Br J Dermatol. 2009;160(1):211–3. doi:10.1111/j.1365-2133.2008.08916.x (Epub 2008 Nov 11).

    Article  PubMed  CAS  Google Scholar 

  7. Situm M, Buljan M. Surgical and histologic pitfalls in the management of lentigo maligna melanoma. G Ital Dermatol Venereol. 2012;147(1):21–7 (PubMed PMID: 22370566).

  8. Shiau CJ, Thompson JF, Scolyer RA. Controversies and evolving concepts in the diagnosis, classification and management of lentigo maligna. Exp Rev Dermatol. 2013;8(2):195–214. doi:10.1586/edm.13.17.

    Article  CAS  Google Scholar 

  9. Dubow BE, Ackerman AB. Ideas in pathology: malignant melanoma in situ: the evolution of a concept. Mod Pathol. 1990;3:734–44.

    PubMed  CAS  Google Scholar 

  10. Hendi A, Wada DA, Jacobs MA, Crook JE, Kortuem KR, Weed BR, Otley CC, Gibson LE. Melanocytes in nonlesional sun-exposed skin: a multicenter comparative study. J Am Acad Dermatol. 2011;65(6):1186–93. doi:10.1016/j.jaad.2010.10.039 (Epub 2011 Jun 17).

    Article  PubMed  Google Scholar 

  11. El Tal AK, Abrou AE, Stiff MA, Mehregan DA. Immunostaining in Mohs micrographic surgery: a review. Dermatol Surg. 2010;36:275–90.

    Article  PubMed  Google Scholar 

  12. Reed JA, Shea CR. Lentigo maligna: melanoma in situ on chronically sun-damaged skin. Arch Pathol Lab Med. 2011;135(7):838–41. doi:10.1043/2011-0051-RAIR.1 (PubMed PMID: 21732771).

    PubMed  Google Scholar 

  13. El Shabrawi-Caelen L, Kerl H, Cerroni L. Melan-A: not a helpful marker in distinction between melanoma in situ on sun-damaged skin and pigmented actinic keratosis. Am J Dermatopathol. 2004;26(5):364–6.

    Article  PubMed  Google Scholar 

  14. Wiltz KL, Qureshi H, Patterson JW, et al. Immununostaining for MART-1 in the interpretation of problematic intraepidermal pigmented lesions. J Cutan Pathol. 2007;34:601–5.

    Article  PubMed  Google Scholar 

  15. Hendi A, Brodland DG, Zitelli JA. Melanocytes in long-standing sun-exposed skin. Arch Dermatol. 2006;142:871–6.

    Article  PubMed  Google Scholar 

  16. Cherpelis BS, Moore R, Ladd S, Chen R, Glass LF. Comparison of MART-1 frozen sections to permanent sections using a rapid 19-minute protocol. Dermatol Surg. 2009;35(2):207–13. doi:10.1111/j.1524-4725.2008.34411.x.

    Article  PubMed  CAS  Google Scholar 

  17. Paraskevas LR, Halpern AC, Marghoob AA. Utility of the Wood’s light: five cases from a pigmented lesion clinic. Br J Dermatol. 2005;152(5):1039–44.

    Article  PubMed  Google Scholar 

  18. Tanaka M, Sawada M, Kobayashi K. Key points in dermoscopic differentiation between lentigo maligna and solar lentigo. J Dermatol. 2011;38(1):53–8. doi:10.1111/j.1346-8138.2010.01132.x.

    Article  PubMed  Google Scholar 

  19. Schiffner R, Schiffner-Rohe J, Vogt T, Landthaler M, Wlotzke U, Cognetta AB, Stolz W. Improvement of early recognition of lentigo maligna using dermatoscopy. J Am Acad Dermatol. 2000;42(1 Pt 1):25–32.

    Article  PubMed  CAS  Google Scholar 

  20. Slutsky JB, Marghoob AA. The zig-zag pattern of lentigo maligna. Arch Dermatol. 2010;146(12):1444. doi:10.1001/archdermatol.2010.307.

    Article  PubMed  Google Scholar 

  21. Robinson JK. Use of digital epiluminescence microscopy to help define the edge of lentigo maligna. Arch Dermatol. 2004;140(9):1095–100.

    Article  PubMed  Google Scholar 

  22. Möller MG, Pappas-Politis E, Zager JS, Santiago LA, Yu D, Prakash A, Kinal A, Clark GS, Zhu W, Puleo CA, Glass LF, Messina JL, Sondak VK, Cruse CW. Surgical management of melanoma-in-situ using a staged marginal and central excision technique. Ann Surg Oncol. 2009;16(6):1526–36. doi:10.1245/s10434-008-0239-x (Epub 2008 Dec 3).

    Article  PubMed  Google Scholar 

  23. McKenna JK, Florell SR, Goldman GD, Bowen GM. Lentigo maligna/lentigo maligna melanoma: current state of diagnosis and treatment. Dermatol Surg. 2006;32(4):493–504 (PubMed PMID: 16681656).

    Google Scholar 

  24. Hazan C, Dusza SW, Delgado R, Busam KJ, Halpern AC, Nehal KS. Staged excision for lentigo maligna and lentigo maligna melanoma: a retrospective analysis of 117 cases. J Am Acad Dermatol. 2008;58(1):142–8 (Epub 2007 Oct 29).

    Article  PubMed  Google Scholar 

  25. Hilari H, Llorca D, Traves V, Villanueva A, Serra-Guillén C, Requena C, Llombart B, Sanmartín O, Guillén C, Nagore E. Conventional surgery compared with slow Mohs micrographic surgery in the treatment of lentigo maligna: a retrospective study of 62 cases. Actas Dermosifiliogr. 2012;103(7):614–23 (Epub 2012 May 7. English, Spanish. PubMed PMID: 22572575).

    Google Scholar 

  26. Abdelmalek M, Loosemore MP, Hurt MA, Hruza G. Geometric staged excision for the treatment of lentigo maligna and lentigo maligna melanoma: a long-term experience with literature review. Arch Dermatol. 2012;148(5):599–604. doi:10.1001/archdermatol.2011.2155.

    Article  PubMed  Google Scholar 

  27. Gaudy-Marqueste C, Perchenet AS, Taséi AM, Madjlessi N, Magalon G, Richard MA, Grob JJ. The “spaghetti technique”: an alternative to Mohs surgery or staged surgery for problematic lentiginous melanoma (lentigo maligna and acral lentiginous melanoma). J Am Acad Dermatol. 2011;64(1):113–8. doi:10.1016/j.jaad.2010.03.014.

    Article  PubMed  Google Scholar 

  28. Alarcón I, Carrera C, Puig S, Malvehy J. Clinical usefulness of reflectance confocal microscopy in the management of facial lentigo maligna melanoma. Actas Dermosifiliogr. 2013 (Epub ahead of print English, Spanish. PubMed PMID: 23642470). doi:10.1016/j.ad.2013.02.011.

  29. Guitera P, Moloney FJ, Menzies SW, Stretch JR, Quinn MJ, Hong A, Fogarty G, Scolyer RA. Improving management and patient care in lentigo maligna by mapping with in vivo confocal microscopy. JAMA Dermatol. 2013;149(6):692–8. doi:10.1001/jamadermatol.2013.2301.

    Article  PubMed  Google Scholar 

  30. Nagore E, Botella-Estrada R. Imiquimod in the treatment of lentigo maligna. Actas Dermosifiliogr. 2011;102(8):559–62. doi:10.1016/j.ad.2011.03.003 (Epub 2011 May 4. Spanish).

    PubMed  CAS  Google Scholar 

  31. Erickson C, Miller SJ. Treatment options in melanoma in situ: topical and radiation therapy, excision and Mohs surgery. Int J Dermatol. 2010;49:482–91.

    Article  PubMed  Google Scholar 

  32. Woodmansee CS, McCall MW. Recurrence of lentigo maligna and development of invasive melanoma after treatment of lentigo maligna with imiquimod. Dermatol Surg. 2009;35:1286–9.

    Article  PubMed  CAS  Google Scholar 

  33. Hedblad MA, Mallbris L. Grenz ray treatment of lentigo maligna and early lentigo maligna melanoma. J Am Acad Dermatol. 2012;67(1):60–8. doi:10.1016/j.jaad.2011.06.029 (Epub 2011 Oct 24).

    Article  PubMed  Google Scholar 

  34. Tsang RW, Liu FF, Wells W, Payne DG. Lentigo maligna of the head and neck: results of treatment by radiotherapy. Arch Dermatol. 1994;130(8):1008–12.

    Article  PubMed  CAS  Google Scholar 

  35. Harwood AR. Conventional radiotherapy in the treatment of lentigo maligna and lentigo maligna melanoma. J Am Acad Dermatol. 1982;6(3):310–6.

    Article  PubMed  CAS  Google Scholar 

  36. Schmid-Wendtner MH, Brunner B, Konz B, Kaudewitz P, Wendtner CM, Peter RU, Plewig G, Volkenandt M. Fractionated radiotherapy of lentigo maligna and lentigo maligna melanoma in 64 patients. J Am Acad Dermatol. 2000;43(3):477–82.

    Article  PubMed  CAS  Google Scholar 

  37. McLeod M, Franca K, Ferris K, Nouri K. Use of carbon dioxide laser to treat lentigo maligna and malignant melanoma in situ, lentigo maligna type. Arch Facial Plast Surg. 2012;14(6):462. doi:10.1001/archfacial.2012.874.

    Article  PubMed  Google Scholar 

  38. Huang CC. New approaches to surgery of lentigo maligna. Skin Therapy Lett. 2004;9(5):7–11 (PubMed PMID: 15146261).

    Google Scholar 

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Correspondence to Amor Khachemoune.

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Kallini, J.R., Jain, S.K. & Khachemoune, A. Lentigo Maligna: Review of Salient Characteristics and Management. Am J Clin Dermatol 14, 473–480 (2013). https://doi.org/10.1007/s40257-013-0044-6

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