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Nonmelanocytic Lesions
Published in Ashfaq A Marghoob, Ralph Braun, Natalia Jaimes, Atlas of Dermoscopy, 2023
Sarah N. Hocker, Harold S. Rabinovitz, Margaret C. Oliviero, Ashfaq A. Marghoob
Solar lentigines are sharply circumscribed, uniformly pigmented macules that are located predominantly on the sun-exposed areas of the skin, such as the dorsal aspects of the hands, the shoulders, and the scalp. These lentigines are a result of hyperplasia of keratinocytes and melanocytes, with increased accumulation of melanin in the keratinocytes. They are induced by ultraviolet light exposure. Unlike freckles, solar lentigines persist indefinitely. Nearly 90% of Caucasians over the age of 60 years have these lesions. Due to the increased prevalence of lentigines in the elderly, these lesions are sometimes referred to as lentigo senilis. However, younger individuals who have a tendency to burn after ultraviolet exposure can also develop lentigines after acute or prolonged ultraviolet light exposure [3,16].
Malignant diseases of the skin
Published in Rashmi Sarkar, Anupam Das, Sumit Sethi, Concise Dermatology, 2021
Anupam Das, Yasmeen Jabeen Bhat
Treatment: This is dictated by the size and exact site of the lesions. Wherever possible, surgical excision is the treatment of choice. However, they may be of a considerable size and alternative treatments may be required. These include locally destructive measures, such as curettage and cautery, and radiotherapy. Cryotherapy should be avoided because it may create non-functioning but viable melanocytes, which may recur without pigmentation to indicate their return. Imiquimod cream has been reported to be effective in some cases. Follow-up is advised after these non-excisional treatments in order to detect recurrence of the lesion; even after surgical excision, it is not uncommon for further lentigo maligna to develop in the vicinity of the original lesion or in other areas of skin. This can be considered part of a ‘field effect’ of susceptibility to the lentiginous atypia.
General Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Rebecca Fish, Aisling Hogan, Aoife Lowery, Frank McDermott, Chelliah R Selvasekar, Choon Sheong Seow, Vishal G Shelat, Paul Sutton, Yew-Wei Tan, Thomas Tsang
How would you classify benign pigmented skin lesions?These develop from melanocytes in the epidermis and dermis.Epidermal lesions include lentigo and café-au-lait patches. Lentigo are skin patches with an increased number of melanocytes. There are three types: simplex (young and middle aged), senilis (elderly) and solar (after sun exposure).Dermal lesions include blue naevi and a Mongolian blue spot.This is a blue/grey pigmented lesion over the sacrum.A halo naevus is surrounded by an area of depigmented skin which regresses, leaving a small scar.
A case of topical imiquimod induced fatigue
Published in Journal of Dermatological Treatment, 2022
Justin Raman, Elizabeth Bisbee, Tricia A. Missall, Sami K. Saikaly
A 69-year-old man presented to our clinic with an asymptomatic 1.1 cm × 0.9 cm brown macule on the left nasal tip (Figure 1) that had been present for several months and demonstrated an irregular pigment network under dermoscopy. Due to the lesion’s cosmetically sensitive location, the patient elected to proceed with confocal microscopy initially prior to undergoing a biopsy, given confocal microscopy’s noninvasive ability to provide in vivo observation of skin structures, including in lentigo maligna (3). Subsequent confocal imaging showed an atypical melanocytic lesion favored to be an early/evolving melanoma in-situ. To minimize the risk of scar formation from both a biopsy and surgery, the patient elected to proceed with topical imiquimod therapy, understanding the risks of its off-label use (4). Given previously published literature suggesting that applications of imiquimod for up to 12 weeks show improved efficacy for lentigo maligna treatment (3,5), he was prescribed 5% imiquimod cream to be applied five times weekly for 12 weeks.
Clinical and histologic features associated with lentigo maligna clearance after imiquimod treatment
Published in Journal of Dermatological Treatment, 2022
R. Kwak, C. Joyce, A. E. Werchniak, J. Y. Lin, H. C. Tsibris
Lentigo maligna (LM) is a slow-growing form of melanoma in situ that occurs on sun-exposed skin. Complete surgical excision can be complicated by amelanotic subclinical extension and background actinic melanocytic hyperplasia (1,2). In patients with limited surgical options, topical imiquimod may be used as off-label treatment, either as a primary treatment instead of surgery or as adjuvant therapy following excision. A systematic review found histologic and clinical clearance rates after primary imiquimod therapy to be 76 and 78%, respectively (3). Adjuvant imiquimod therapy in cases with involved or close surgical margins has higher reported clearance rates of 94–95% (4–7). In comparison, recurrence rates following Mohs micrographic surgery or staged excision are estimated at 0.6–2% (8–12). Recurrence rates following conventional excision vary based on surgical margins taken; however, recent studies have found 5–20% recurrence rates (9–13).
Efficacy of a laser with a pulse duration of 300 ps in skin rejuvenation and treatment of pigmentation disorders in Asians: a series of four cases
Published in Journal of Cosmetic and Laser Therapy, 2021
Jie Hoon Kim, Soo Eun Jung, Yun Hwa Park
For the treatment of ABNOM lesions, the parameters were set at a spot size of 10 mm (collimate handpiece), fluence of 0.6 J/cm2, and pulse rate of 10 Hz, using the pulse stacking technique for 2–3 s. In the same session, lentigo lesion treatment was administered, and the parameters were set at a spot size of 10 mm (collimated handpiece), fluence of 0.3 J/cm2, and pulse rate of 10 Hz. Using the sliding and circular technique, the laser beam was repeatedly passed over the lesions until mild erythema appeared. She received this treatment every 2 weeks for a total of 12 treatments. Immediately after treatment, an ice pack was applied to cool the treatment area; systemic or topical corticosteroids and antibiotics were not prescribed. The patient was advised to avoid exposure to sunlight and to apply sunscreen during the treatment period. The treated ABNOM lesions and lentigo had almost disappeared after laser treatment (Figure 3b).