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At least 19 recordsLinked to original sources

PubMed2004

A comparison of dermoscopic features among lentigo senilis/initial seborrheic keratosis, seborrheic keratosis, lentigo maligna and lentigo maligna melanoma on the face.

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.

Color↗

PubMed2004

Lentigo maligna and lentigo maligna melanoma in young adults.

BACKGROUND: We observed two young women with skin types II to III according to Fitzpatrick's classification who developed pigmented macules in the face that were histologically diagnosed as lentigo maligna melanomas. OBJECTIVE: The objective of this study was to examine lentigo maligna melanoma in young adults. METHODS: According to private photographs of one of those patients a precursor lesion was clinically apparent as early as in her 26th year. Ten years later, the diagnosis of a lentigo maligna melanoma was made. The other patient was diagnosed with lentigo maligna at the age of 37. After excision, a relapse occurred in her 39th year. At this time histopathology revealed an early invasive lentigo maligna melanoma. RESULTS: These case reports demonstrate that the diagnosis of both lentigo maligna and lentigo maligna melanoma cannot be dismissed because of young age or well-tanning skin types. CONCLUSION: We conclude that owing to changes in social behavior and sporting activities with high short-term ultraviolet exposures, one must be aware of the possibility of an unusual early onset of lentigo maligna and lentigo maligna melanoma already in the third and fourth decade of life. Furthermore, our observations support the effectiveness of dermatoscopy in diagnosing ambiguous pigmented skin lesions in sun-exposed skin.

Adult↗

PubMed2002

Recurrent lentigo maligna as amelanotic lentigo maligna melanoma.

Amelanotic lentigo maligna and lentigo maligna melanoma are extremely rare tumours. Even rarer is a recurrent amelanotic lentigo maligna or amelanotic lentigo maligna melanoma at the site of a previously removed pigmented lentigo maligna. We describe two cases of recurrent amelanotic lentigo maligna melanoma manifesting as erythematous plaques evolved from previously excised pigmented lentigo maligna.

Aged↗

PubMed1979

Treatment of lentigo maligna and lentigo maligna melanoma.

The results of treatment of 42 cases of lentigo maligna and 16 of lentigo maligna melanoma at the New York University Medical Center was reviewed. The recurrence rate after surgical excision of 22 lesions of lentigo maligna was 9% (2/22), but after treatment of 20 such lesions with destructive techniques (X rays, curettage-electrodesiccation, cryosurgery), it was 35% (7/20). Of 11 cases of lentigo maligna melanoma that were excised, none recurred locally, but fatal metastases ensued in one case. Five patients who were eventually classified as having lentigo maligna melanomas had been treated by destructive techniques. In four of them there were local recurrences and in two, metastases as well; the fifth patient had metastases without local recurrence. On the basis of this review of these 58 cases, we conclude that surgical excision and careful histologic study of step sections through the entire lesion insure accurate diagnosis and provide the highest cure rates for lentigo maligna and lentigo maligna melanoma.

Adult↗

PubMed1976

Fluorescence-microscopic investigations of pigment cells of lentigo maligna (melanosis circumscripta praeblastomatosa Dubreuilh) and lentigo maligna melanoma.

With fluorescence-histochemical methods (formalin-induced fluorescence), the different stadia of development of lentigo maligna (Morbus Dubreuih) and lentigo maligna melanoma were investigated. In this way, the special stadia can be clearly characterized using the fluorescence-microscope. In the earliest stadium of malignancy, only the pigment-cells of the basal part of the epidermis seem to be numerous. At this time, these cells are mainly arranged as palisades in the basal layer, and their strongest dendrites are usually directed towards the corneal layer. As the malignancy progresses, the pigment-cells are arranged in several layers in the basal epidermis. In this case, polymorphism of the cells is obvious and their dendrites spread in all directions. A further stadium shows pathological alterations resembling a lentigo with long rete ridges. The atypical cells cluster together into the so-called pseudonests, predominantly at the tips of these rete ridges. With the fluorescence-microscope, dendrites are seldom visible here. In the stadium of tumorous growth, all above-described alterations of the epidermis in lentigo maligna are no longer detectable. Malignant cells in the dermis, which form as a tumor mode, seldom show dendrites. These cells are mainly round or oval-shaped; at best there are some spindle cells in certain areas of the tumor. The epidermis covering the tumor node is infiltrated by some tumor cells but the characteristic alterations as described above for the various stadia of lentigo maligna are no longer visible. Even fluorescence-microscopically, a tumor node of lentigo maligna does not seem to be different from a primary nodular melanoma or a tumor node of a superficial spreading melanoma, if the flat parts of the tumors are not considered in the diagnosis.

Humans↗

PubMed1993

Management of lentigo maligna and lentigo maligna melanoma with paraffin-embedded tangential sections: utility of immunoperoxidase staining and supplemental vertical sections.

BACKGROUND: The use of frozen sections in the management of lentigo maligna and lentigo maligna melanoma has been the focus of some controversy. OBJECTIVE: Our purpose was to utilize paraffin-embedded tangential sections in the management of two cases of lentigo maligna and three cases of lentigo maligna melanoma. METHODS: A modification of Mohs micrographic surgery using rush paraffin-embedded sections with adjunctive immunoperoxidase staining (HMB-45) and supplemental vertical sections was employed. RESULTS: This method resulted in enhanced histologic evaluation of section margins and did not compromise the diagnosis of the primary invasive melanoma or Breslow measurements. CONCLUSION: Mohs micrographic surgery modified by the use of rush paraffin-embedded sections allows adjunctive immunoperoxidase staining and supplemental vertical sections that may be helpful in the management of lentigo maligna and lentigo maligna melanoma.

Aged↗

PubMed1999

Simultaneous occurrence of multiple melanoma in situ on sun-damaged skin (lentigo maligna), solar lentigo and labial melanosis: the value of dermoscopy in diagnosis.

We report on a patient developing simultaneous occurrence of lentigo maligna lesions, solar lentigines and an extensive melanosis of the oral mucosa. Diagnostically, epiluminescence microscopy had a relevant role in the preoperative assessment and selection of suspicious pigmented lesions, as the lesions histologically labelled as lentigo maligna and solar lentigo were clinically indistinguishable. We review the clinical, dermoscopic and histopathologic differential diagnosis of solar lentigo, malignant lentigo and mucosal melanosis with other melanocytic and keratinocytic lesions and discuss the possible relationship between these entities.

Aged↗

PubMed1990

[The subclinical portion in the periphery of lentigo maligna and lentigo maligna melanoma].

Lentigo maligna is a precancerosis or a melanoma in situ, whose level of malignancy has not yet been definitively clarified. Recurrences are not rare after excision, even when an ample safe margin is observed. One reason for this is the existence of a subclinical ramification in the marginal area of the lentigo maligna. Such subclinical ramifications were investigated by means of excision with histological monitoring of the margins by the paraffin section technique. There was a clear relationship between the frequency of these ramifications and the clinical safe margin left in 64 excisions. With the aid of parametric evaluation methods the distribution of the subclinical portion referred to the distance from the clinical margin could be determined with a special formula. If an invasion, in the form of a lentigo maligna melanoma had already taken place, then the subclinical portion within the marginal area was significantly more extensive. For the treatment of lentigo maligna, and especially of lentigo maligna melanoma, we therefore recommend excision with histological monitoring of the margins. There were no local recurrences within an average follow-up period of about 2 1/2 years.

Adult↗

PubMed1999

Lentigo maligna and malignant melanoma in situ, lentigo maligna type.

Some authors have considered lentigo maligna to be an atypical melanocytic proliferation, whereas others have considered it to be melanoma in situ. We reviewed 50 cases of lentigo maligna. We have identified two subsets of lesions. The first has atypical melanocytic hyperplasia, which we postulate to be correctly designated lentigo maligna. The second subset has the following features in addition to the melanocytic hyperplasia: individual and nests of cells at varying layers of the epidermis, confluence of the melanocytes replacing the basilar region, uniformity of the cytological atypia, and nesting of uniformly atypical melanocytes. These lesions we designate as malignant melanoma in situ, lentigo maligna type. We are proposing that the lesions that have been termed lentigo maligna represent a spectrum of atypia and that the application of some of the traditional features for the diagnosis melanoma may permit the segregation of more and less aggressive lesions.

Aged↗

PubMed1992

Reticulated black solar lentigo ('ink spot' lentigo).

BACKGROUND AND DESIGN: Pigmented lesions that are black and have an irregular outline are often considered suspicious for melanoma; however, these features may be seen in benign lesions. The reticulated black solar lentigo is such a lesion and is described in a clinicopathologic study of nine lesions in eight patients. RESULTS: The "ink spot" lentigo is distinguished clinically by its color and wiry or beaded, markedly irregular outline. It has a reticulated pattern and most resembles a spot of ink on the skin. In this series of patients, the lesions were limited to sun-exposed areas of the body and had a distribution pattern similar to that of solar lentigines. Although all the patients were of Celtic ancestry and had numerous solar lentigines, they usually had only one black lentigo (range, one to four; mean, 1.6; median, one). Histologic evaluation, including electron microscopy and dopa-incubated vertical sections, demonstrated lentiginous hyperplasia of the epidermis, marked hyperpigmentation of the basal layer with "skip" areas that involved the rete ridges, and a minimal increase in the number of melanocytes. CONCLUSIONS: Because of their dark color, irregular border, and limited number, reticulated black solar lentigines were of concern to patients and primary care physicians. However, the characteristic features of these lesions allow one to make the clinical diagnosis of a benign lentigo.

Adult↗

PubMed2002

In vivo examination of lentigo maligna and malignant melanoma in situ, lentigo maligna type by near-infrared reflectance confocal microscopy: comparison of in vivo confocal images with histologic sections.

In vivo confocal microscopy can noninvasively image thin en face sections within living intact human tissue with high resolution and contrast. This evolving technique may provide clinicians with tools to help detect lentigo maligna lesion progression in vivo and may be important in defining tumor margins, thus providing a more definitive surgical eradication of lentigo maligna and malignant melanoma in situ, lentigo maligna type. We present a case of malignant melanoma in situ, lentigo maligna type, and we describe the images seen with confocal microscopy in correlation with routine histopathology.

Aged↗

PubMed1983

Rapid progression of lentigo maligna to deeply invasive lentigo maligna melanoma. Report of two cases.

Two patients had lesions of lentigo maligna that evolved into deeply invasive (level 4-5) lentigo maligna melanoma during a relatively short period (two years and four years, respectively). In both patients, the clinical impression of lentigo maligna had been difficult to confirm by histopathologic analysis until the invasive tumor had developed. Both patients were actively followed up during this period of evolution, with our intention of detecting any early changes suggestive of invasive melanoma. Since deep invasion developed despite close clinical supervision, a more aggressive approach to the treatment of lentigo maligna may be warranted.

Facial Neoplasms↗

PubMed1978

Lentigo maligna and lentigo maligna melanoma. Recognition and treatment.

Lentigo maligna is the preinvasive stage of lentigo maligna melanom, which is a specific type of cutaneous malignant melanom found almost exclusively in the head and neck area. The distinguishing features and the biological behavior of this disease are discussed. Emphasis is placed on early diagnosis by clinical differentiation from other pigmented lesions and by biopsy specimen. Treatment by adequate surgical removal with appropriate reconstruction is discussed and illustrated with case reports.

Aged↗

PubMed1980

The radiotherapy of lentigo maligna and lentigo maligna melanoma of the head and neck.

Between 1958 and 1977, 8 cases of lentigo maligna (LM) and 15 cases of lentigo maligna melanoma (LMM) were treated with radiotherapy at the Princess Margaret Hospital. Only 1 of the 8 cases of LM recurred following irradiation and this recurrence was controlled with further radiotherapy. Of 15 cases of LMM, 14 were controlled by irradiation for periods ranging from two months to six years postradiotherapy; the 1 recurrence was salvaged with local excision. Conventional orthovoltage irradiation using doses of 4500--5000 rad in ten to 15 fractions has been found to be highly effective in controlling this disease. The lesion may take up to 24 months to completely regress following irradiation. The benefits of this modality of treatment for a disease process which predominantly occurs in the head and neck region of elderly people is discussed in detail. The results are compared with other methods of irradiation (Miescher's technique) and other modalities of treatment.

Aged↗

PubMed1987

The risk of progression of lentigo maligna to lentigo maligna melanoma.

An analysis is presented which estimates the risk of progression of lentigo maligna (LM) to lentigo maligna melanoma (LMM) in U.S. whites using three data sources: the Health and Nutrition Examination Survey I for estimation of the age-specific prevalence of LM; the Surveillance, Epidemiology, and End Results Program for estimation of the age-specific incidence of melanoma; and the data from three melanoma registries for estimation of the age-specific case fraction of LMM among all invasive melanomas. The risk varies with age and is likely to be greater than estimated here for patients who present themselves for evaluation of changes in a lesion of LM. Our analysis suggests that the risk of progression from LM to LMM is substantially lower than is commonly believed.

Adolescent↗

PubMed1980

Treatment of lentigo maligna and lentigo maligna melanoma.

Thirty-eight cases of lentigo maligna and 22 cases of lentigo maligna melanoma, were reviewed in order to compare cure rates of various methods of treatment. Surgical excision resulted in the best cure rate (91%); destructive modalities were less successful (45%). All lesions treated with 5% 5-fluorouracil recurred.

Adult↗

PubMed2004

Management of lentigo maligna and lentigo maligna melanoma with staged excision: a 5-year follow-up.

OBJECTIVE: To assess the long-term cure rate for treatment of lentigo maligna (LM) and lentigo maligna melanoma (LMM) by means of a staged, margin-controlled, vertical-edged excision with rush permanent specimens and a radial sectioning technique. DESIGN: Retrospective follow-up study. SETTING: University-affiliated and private-practice dermatologic surgery clinics. PATIENTS: Fifty-nine patients treated for 55 LMs and 7 LMMs between January 1, 1990, and December 31, 2001. INTERVENTIONS: The technique included vertical excision with initial 2- to 3-mm margins examined by rush permanent sections (prepared and read within 24 hours). Further excision took place as guided by histologic findings. Data on patient and lesion characteristics were obtained via a medical chart review. Patients were then contacted and examined for local recurrence. Biopsies were performed on all patients with possible recurrence on clinical examination. MAIN OUTCOME MEASURES: Local recurrence of LM or LMM. RESULTS: After a mean follow-up of 57 months (median, 54 months; 293.8 person-years), 95% of patients were free of recurrence. Three patients had local recurrence and no patients had evidence of metastasis. Two of the 3 local recurrences were of previously excised LM, and 1 was of an LMM. Half (32) of all lesions required 2 or more stages. One required more than 4 stages. The average margin of excision was 0.55 cm. Three of the 58 lesions read as LM on biopsy were found to have invasive disease (LMM) at the time of definitive excision. CONCLUSIONS: The technique described herein for the treatment of LM and LMM provides a long-term disease-free survival of 95%. The cure rate is greater than that reported for standard excision and is similar to that for other margin-control techniques. To our knowledge, this is the largest reported study and has the longest follow-up for this excision method for LM and LMM.

Adult↗

PubMed2004

Surgical margins for lentigo maligna and lentigo maligna melanoma: the technique of mapped serial excision.

OBJECTIVES: To assess the margins required for excision of lentigo maligna (LM) and lentigo maligna melanoma (LMM) by the technique of mapped serial excision (MSE), and to assess the efficacy of MSE. DESIGN: An interventional, prospective, noncontrolled case series. SETTING: Tertiary referral, dermatologic surgery unit. PATIENTS: Consecutive patients with head and neck LM or LMM who underwent MSE between March 1, 1993, and October 31, 2002. INTERVENTION: The MSE of LM or LMM. MAIN OUTCOME MEASURES: The number of 5-mm levels for excision of LM and LMM and recurrence. RESULTS: One hundred sixty-one LMs or LMMs in 155 patients were treated. Thirty percent (37 of 125) of LMs required more than 5-mm margins. For LMMs less than 1 mm in Breslow thickness, 12% (4/32) required more than 10-mm margins. For primary tumors, 20% of LMs (18 of 91) required more than 5-mm margins, while 10% of LMMs less than 1 mm in Breslow thickness (2 of 21) required more than a 10-mm margin. For recurrent tumors, 56% of LMs (19/34) required more than a 5-mm margin. Mean follow-up of 38 months (range, 5-100 months) showed 4 recurrences (2%) after MSE. The extrapolated recurrence at 5 years was 5.0%. CONCLUSIONS: The current recommendations of 5-mm margins for LM and 10-mm margins for LMM less than 1 mm in Breslow thickness are often insufficient. Our results demonstrate the importance of margin-controlled excision, particularly in recurrent lesions. The use of MSE offers a high cure rate, in conjunction with tissue conservation.

Adult↗