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Non-erythematous lesions
Published in Richard Ashton, Barbara Leppard, Differential Diagnosis in Dermatology, 2021
Richard Ashton, Barbara Leppard
Lentigo maligna is a variant of in-situ melanoma where a large (1–3 cm size) brown patch on sun exposed skin is seen usually in an elderly patient (Fig. 9.71). It tends to grow very slowly over years, but later an invasive melanoma (termed a lentigo maligna melanoma) can develop within it as a papule or nodule within the original patch (Fig. 9.72).
Malignant diseases of the skin
Published in Rashmi Sarkar, Anupam Das, Sumit Sethi, Concise Dermatology, 2021
Anupam Das, Yasmeen Jabeen Bhat
Clinical features: Lentigo maligna is a slowly progressive, pre-neoplastic disorder of melanocytes, which develops insidiously on exposed areas of skin, particularly the skin of the face. The lesion itself is a pigmented macule with a well-defined, rounded or polycylic edge, which may be up to 5 cm in diameter or even larger (Figure 13.14). A characteristic feature is the varying shades of brown and black contained within the lesion – a feature known as variegation.
The skin
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Malignant melanoma in situ (MMIS) represents an early intraepithelial stage of malignant melanoma. It presents as a slowly growing, asymmetrical, irregular, relatively flat pigmented lesion with colour variegation. Lentigo maligna and superficial spreading are the two main clinicopathological forms of intraepithelial melanoma which differ in the anatomical distribution, histological characteristics and risks of progression. Lentigo maligna arises on chronically sun-damaged skin usually of the facial region of elderly patients. Superficial spreading type of MMIS more commonly affects non-sun damaged areas of the skin like the back. Of the two subtypes, lentigo maligna tends to have a more indolent course and can sometimes remain in this stage over decades before acquiring the potential to metastasize. Indeed, some view lentigo maligna as a broad histological spectrum of which some but not all are atypical enough to warrant a diagnosis of MMIS.
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).
The use of in vivo reflectance confocal microscopy for the diagnosis of melanoma
Published in Expert Review of Anticancer Therapy, 2019
Marina Agozzino, Elvira Moscarella, Graziella Babino, Stefano Caccavale, Vincenzo Piccolo, Giuseppe Argenziano
Lentigo maligna (LM) is a subtype of melanoma that usually presents itself as a pigmented macula with poorly defined edges in severely sun-damaged skin of elderly patients, especially in the face area. The dermoscopic criteria of LM are distinct from those used for melanomas on the body and extremities. Gray color forming dots or granules surrounding adnexal openings is an important feature for early diagnosis [42]. Pigment surrounds follicular openings in an asymmetric zig-zag pattern in early phases, but, if LM progresses, it invades the inter-follicular space, forming polygonal lines, rhomboidal structures, and homogeneous dark pigmented areas. Dermoscopical differential diagnosis between LM and other non-melanocytic entities (pigmented actinic keratosis, solar lentigo, or lichen-planus like keratosis) can be challenging [43–46].
Mohs surgery for the treatment of lentigo maligna and lentigo maligna melanoma – a systematic review
Published in Journal of Dermatological Treatment, 2021
Ajay N. Sharma, Delila P. Foulad, Linda Doan, Patrick K. Lee, Natasha Atanaskova Mesinkovska
Lentigo maligna (LM) is a melanocytic lesion that occurs on sun-exposed skin, often on the head and neck region of older adult patients. Currently, LM is widely reported as a form of ‘in situ’ melanoma, where malignant cells are confined to the epidermis. While slowly growing, this neoplasm can progress to the point of dermal invasion and become lentigo maligna melanoma (LMM).