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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] [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.
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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
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2
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Huynh J, Leiter U, Garbe C, Shiderova G, Walter V, Eigentler T, Scheu A, Häfner HM, Schnabl SM. Sentinel lymph node biopsy for lentigo maligna melanoma under local anaesthesia. J Eur Acad Dermatol Venereol 2024; 38:84-92. [PMID: 37611257 DOI: 10.1111/jdv.19456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 08/03/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Lentigo maligna melanoma is mainly localized in the head and neck region in elderly patients. Due to its slow horizontal growth, it has a good prognosis compared to other melanoma subtypes, but specific data are rare. OBJECTIVES The aim of this study was to investigate sentinel lymph node biopsy in lentigo maligna melanoma under local anaesthesia and to discuss the benefit. METHODS Investigation of patients with lentigo maligna melanoma and tumour thickness ≥1 mm treated at the Department of Dermatology, University Medical Centre Tuebingen, between January 2008 and October 2019. RESULTS In total, 204 patients (126 SLNB, 78 non-SLNB) with a median age of 75.7 years (SLNB: 73.3 years, non-SLNB: 79.7 years) could be included. Sixteen of 126 (12.7%) sentinel lymph nodes were positive. Five-year overall survival was 87.9% (88.5% SLNB; 87.4% non-SLNB) and 5-year distant metastasis-free survival was 85.8% (85.4% SLNB; 86.7% non-SLNB). There was no significant difference for distant metastasis-free survival (p = 0.861) and overall survival (p = 0.247) between patients with and without sentinel lymph node biopsy. CONCLUSIONS Sentinel lymph node biopsy in lentigo maligna melanoma under local anaesthesia is a safe and simple method, even in very old patients. However, LMM has a very good 5-year overall survival. In high-risk patients with high tumour thickness and/or ulceration, adjuvant immunotherapy can now be offered without the need to perform this procedure.
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Affiliation(s)
- Julia Huynh
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ulrike Leiter
- Department of Dermatology, University of Tuebingen, Tübingen, Germany
| | - Claus Garbe
- Department of Dermatology, University of Tuebingen, Tübingen, Germany
| | - Galina Shiderova
- Department of Dermatology, University of Tuebingen, Tübingen, Germany
| | - Vincent Walter
- Department of Dermatology, University of Tuebingen, Tübingen, Germany
| | - Thomas Eigentler
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Alexander Scheu
- Department of Dermatology, University of Tuebingen, Tübingen, Germany
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3
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Daude M, Dinulescu M, Nguyen JM, Maillard H, Le Duff F, Machet L, Beylot-Barry M, Legoupil D, Wierzbicka-Hainaut E, Bedane C, Leccia MT, Debarbieux S, Meyer N, Monestier S, Bens G, Denis MG, Bossard C, Vergier B, Khammari A, Dréno B. Efficacy of imiquimod in the management of lentigo maligna. J Eur Acad Dermatol Venereol 2023; 37:1785-1791. [PMID: 37114291 DOI: 10.1111/jdv.19141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/07/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Lentigo maligna (LM) is a melanocytic proliferation occurring on photo-exposed skin that may progress to LM melanoma. Surgery is recommended as first-line treatment. Excision margins of 5-10 mm remain, without international consensus. Several studies have shown that imiquimod, an immunomodulator, induces LM regression. This study investigated the effect of imiquimod versus placebo in neoadjuvant settings. PATIENTS AND METHODS We performed a prospective, randomized, multicentre, phase III clinical study. Patients were randomly assigned in 1:1 ratio to receive imiquimod or placebo for 4 weeks, followed by LM excision 4 weeks after the last application of imiquimod or placebo. The primary endpoint was extra-lesional excision, with a 5 mm margin from the residual pigmentation after imiquimod or vehicle. Secondary endpoints included the gain on the surface removed between the two groups; number of revision surgeries to obtain extra-lesional excisions; relapse-free time; and number of complete remissions after treatment. RESULTS A total of 283 patients participated in this study; 247 patients, 121 patients in the placebo group and 126 in the imiquimod group, accounted for the modified ITT population. The first extralesional extirpation was performed in 116 (92%) imiquimod patients and in 102 (84%) placebo patients; the difference was not significant (p = 0.0743). Regarding the surface of LM, imiquimod reduced the LM surface (4.6-3.1 cm2 ) significantly (p < 0.001) more compared to the placebo (3.9-4.1 cm2 ). CONCLUSION Imiquimod reduces the lentigo maligna surface after 1 month of treatment, without a higher risk of intralesional excision and with a positive aesthetic outcome.
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Affiliation(s)
- Marie Daude
- Nantes Université, INSERM, CNRS, CHU Nantes, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302/EMR6001, Nantes, France
| | | | - Jean-Michel Nguyen
- Biostatistics and Epidemiology, Hôpital Saint Jacques - CHU Nantes, Nantes, France
| | | | - Florence Le Duff
- Department of Dermatology, CHU Nice, Centre de recherche Clinique, Nice, France
| | | | | | | | | | | | | | - Sébastien Debarbieux
- Department of Dermatology, Hospices Civiles de Lyon, Hôpital Lyon Sud, Pierre Bénite, France
| | - Nicolas Meyer
- Department of Dermatology, CHU Toulouse, Toulouse, France
| | | | - Guido Bens
- Department of Dermatology, CHU Orléans, Orléans, France
| | - Marc G Denis
- Nantes Université, INSERM, CNRS, CHU Nantes, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302/EMR6001, Nantes, France
| | | | | | - Amir Khammari
- Department of Dermatology, Nantes Université, Univ Angers, CHU Nantes, CIC 1413, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302, Nantes, France
| | - Brigitte Dréno
- Nantes Université, INSERM, CNRS, CHU Nantes, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302/EMR6001, Nantes, France
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4
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Zoutendijk J, Koljenovic S, Wakkee M, Mooyaart A, Nijsten T, van den Bos R. Clinical findings are not helpful in detecting lentigo maligna melanoma in patients with biopsy-proven lentigo maligna. J Eur Acad Dermatol Venereol 2022; 36:2325-2330. [PMID: 35730990 PMCID: PMC9796129 DOI: 10.1111/jdv.18346] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/29/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Lentigo maligna (LM) based on biopsy material might be lentigo maligna melanoma (LMM) after excision. OBJECTIVES Investigate whether clinical and dermoscopic mapping increases the detection rate of LMM when investigating staged excision specimens of biopsy proven LM. METHODS Patients with biopsy-proven LM planned for staged excision were included. Using clinical inspection and dermoscopy, spots suspicious for LMM were marked. After the excision, needles were placed at the marked spots. Histological examination using vertical sections was done at the needles followed by the standard amount of vertical sections. RESULTS In 28 of the 58 biopsy-proven LM, there was clinical suspicion of LMM, only 3 of these 28 cases were upgraded into LMM. These three cases showed LMM in other sections, whereas only 1 case showed LMM around the needle. Within the group without clinical suspicion of LMM, 2 cases were LMM. Biopsy-proven LM were in fact LMM in 8.6% of the cases and were found without the clinical guidance of the dermatologist. CONCLUSIONS 8.6% of the biopsy-proven LM were LMM after complete histological examination. In this study, the dermatologist was not able to increase the detection rate of LMM by using clinical and dermoscopic mapping.
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Affiliation(s)
- J. Zoutendijk
- Department of Dermatology, Erasmus MC Cancer InstituteUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - S. Koljenovic
- Department of PathologyErasmus MC University Medical CenterRotterdamThe Netherlands,Department of PathologyAntwerp University HospitalAntwerpBelgium
| | - M. Wakkee
- Department of Dermatology, Erasmus MC Cancer InstituteUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - A.L. Mooyaart
- Department of PathologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | - T. Nijsten
- Department of Dermatology, Erasmus MC Cancer InstituteUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - R.R. van den Bos
- Department of Dermatology, Erasmus MC Cancer InstituteUniversity Medical Center RotterdamRotterdamThe Netherlands
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5
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Kurn HA, Abercrombie M, Tzellos T, Dellavalle RP. From the Cochrane library: Interventions for melanoma in situ, including lentigo maligna. J Am Acad Dermatol 2022; 87:e115-e116. [PMID: 35640801 DOI: 10.1016/j.jaad.2022.05.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 05/20/2022] [Accepted: 05/21/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Heidi A Kurn
- Internal Medicine Residency, Saint Joseph Mercy Hospital System, Ann Arbor, Michigan
| | - McKenna Abercrombie
- Dermatology Residency, Saint Joseph Mercy Hospital System, Ann Arbor, Michigan
| | | | - Robert P Dellavalle
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
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Abstract
Lentigo maligna (LM) is a melanocytic neoplasm found on chronically sun-exposed areas of the body, particularly the head and neck. It commonly occurs in the elderly and has been referred to as a "senile freckle." It has also been termed "Hutchinson melanotic freckle," as it was first described by John Hutchinson in 1892. LM is defined as melanoma in situ and thus confined to the epidermis. LM lesions that invade the dermis are termed lentigo maligna melanoma, 1 of the 4 subtypes of malignant melanoma.
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Affiliation(s)
- Jacob D Franke
- Southern Illinois University, School of Medicine, 747 N. Rutledge Street, Springfield, IL 62702, USA
| | - Katlyn M Woolford
- Southern Illinois University, School of Medicine, 747 N. Rutledge Street, Springfield, IL 62702, USA
| | - Michael W Neumeister
- Department of Surgery, The Elvin G Zook Endowed Chair - Institute for Plastic Surgery, Southern Illinois University, 747 N Rutledge Street #3, Springfield, IL 62702, USA.
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Abstract
Melanoma accounts for approximately 1% of all skin cancers but contributes to almost all skin cancer deaths. The developing picture suggests that melanoma phenotypes are driven by epigenetic mechanisms that reflect a complex interplay between genotype and environment. Furthermore, the growing consensus is that current classification standards, notwithstanding pertinent clinical history and appropriate biopsy, fall short of capturing the vast complexity of the disease. This article summarizes the current understanding of the clinical picture of melanoma, with a focus on the tremendous breakthroughs in molecular classification and therapeutics.
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Affiliation(s)
- Sarem Rashid
- Department of Dermatology, Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02466, USA; Boston University School of Medicine, Boston, MA, USA
| | - Hensin Tsao
- Department of Dermatology, Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02466, USA.
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8
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Change in lentigo maligna score assessed by in vivo reflectance confocal microscopy after 1 month of imiquimod treatment for lentigo maligna management. J Am Acad Dermatol 2021; 86:1042-1048. [PMID: 33785385 DOI: 10.1016/j.jaad.2021.03.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/18/2021] [Accepted: 03/18/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Treatment of lentigo maligna (LM) is challenging because of the potential functional and esthetic surgical sequelae. Imiquimod has been proposed as a treatment for LM. Reflectance confocal microscopy (RCM) is a noninvasive method for the diagnosis of LM and margin assessment. OBJECTIVES To compare the overall LM score (LMS) assessed by RCM before and 1 month after the start of imiquimod treatment compared to placebo and to define the immunohistochemical (IHC) profile of responders to imiquimod. METHODS A controlled randomized study was conducted. Forty patients underwent RCM examination with calculation of the LMS at baseline and after 1 month of treatment. An IHC analysis of excised tissues was performed. RESULTS The 1-month LMS was significantly lower in patients treated with imiquimod compared to those treated with placebo (P < .001). The criteria in the imiquimod-treated patients that demonstrated significant decrease were nonedged papillae; large, round pagetoid cells; atypical cells at the dermoepidermal junction; and follicular location of atypical cells. IHC analysis showed a higher level of interferon gamma in the resected specimens of patients responding to imiquimod (P = .04). LIMITATIONS Sample size was small. CONCLUSION Assessing the LMS by RCM was useful to monitor LM response to imiquimod accurately.
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Chapireau D, Bashir SJ, Fan K. Holistic Patient Assessment: Dermatology in Dental Practice. Prim Dent J 2020; 9:37-42. [PMID: 32519610 DOI: 10.1177/2050168420911028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
As part of the holistic approach to their patients, General Dental Practitioners are well placed to identify common skin lesions. Awareness and recognition of worrying lesions allow timely and appropriate referrals for further investigation and treatment. In this paper, we review benign, premalignant and malignant skin lesions, as well as genetic skin conditions. Past medical, family and social history (including sun exposure and previous cutaneous malignancy) is important. Examination includes the lesion, the skin type and the regional lymph nodes. The different common lesions are described, and the epidemiology, clinical features and treatment are discussed. Screening for skin lesions on the head and neck may be undertaken as part of overall dental care as part of the holistic examination of patients. Particularly with precancerous lesions and skin cancer, an early detection and referral from a dentist can expedite treatment and improve prognosis.
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Affiliation(s)
- David Chapireau
- King's College Hospital.,Consultant Oral and Maxillofacial Surgeon, King's College Hospital, Reader in Oral and Maxillofacial Surgery, King's College London
| | - Saqib J Bashir
- Consultant Dermatologist, King's College Hospital.,Consultant Oral and Maxillofacial Surgeon, King's College Hospital, Reader in Oral and Maxillofacial Surgery, King's College London
| | - Kathleen Fan
- Consultant Oral and Maxillofacial Surgeon, King's College Hospital, Reader in Oral and Maxillofacial Surgery, King's College London
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10
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Matas-Nadal C, Malvehy J, Ferreres JR, Boada A, Bodet D, Segura S, Salleras M, Azon A, Bel-Pla S, Bigata X, Campoy A, Curcó N, Dalmau J, Formigon M, Gonzalez A, Just M, Llistosella E, Nogues ME, Pedragosa R, Pujol JA, Sabat M, Smandia JA, Zaballos P, Puig S, Martí RM. Increasing incidence of lentigo maligna and lentigo maligna melanoma in Catalonia. Int J Dermatol 2018; 58:577-581. [PMID: 30548854 DOI: 10.1111/ijd.14334] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 10/30/2018] [Accepted: 11/14/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recent epidemiological studies suggest that past data where superficial spreading melanoma was by far the most common subtype of melanoma may not reflect current patterns of sun exposure or other risk factors more involved in other subtypes of melanoma as lentigo maligna (LM) or lentigo maligna melanoma (LMM). METHODS In order to measure the current situation in our country, all cases of LM and LMM diagnosed in 23 hospitals in Catalonia, from 2000 to 2007, were recorded. RESULTS Although for the global period LM/LMM represented only 8.4% of cases, an increasing trend in this percentage was observed throughout the study period (from 6.9% [27 cases] in 2000 to 13.1% [94 cases] in 2007). Also, an increasing incidence of LM/LMM was observed, especially in chronically sun-exposed areas (85.5% involving the head and neck region). During the 8 years of the registry, the mean Breslow thickness of LMM remained stable. However, the increase in the number of LM (in situ) cases was significantly higher than the increase of the invasive ones. CONCLUSIONS An important observation from this data is that aging of population and current sun exposure patterns could keep increasing the incidence of LM/LMM, which may become an important public healthcare problem, over the other histological subtypes. In order to establish primary or secondary preventive measures to the LM/LMM risk-population, it is imperative to highlight the importance of chronic sun damage as a melanoma risk factor, and not only sunburn, most commonly addressed in melanoma prevention campaigns.
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Affiliation(s)
- Clara Matas-Nadal
- Department of Dermatology, Hospital Universitari Arnau de Vilanova, University of Lleida, IRBLleida, Lleida & CIBERONC, Lleida, Spain
| | - Josep Malvehy
- Department of Dermatology, Hospital Clínic de Barcelona (Melanoma Unit), University of Barcelona, IDIBAPS, Barcelona & CIBERER, Barcelona, Spain
| | - Jose Ramon Ferreres
- Department of Dermatology, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | - Aram Boada
- Department of Dermatology, Universitari Germans Trias i Pujol, Badalona, Spain
| | - Domingo Bodet
- Department of Dermatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Sonia Segura
- Department of Dermatology, Hospital del Mar, IMIM, Barcelona, Spain
| | - Montse Salleras
- Department of Dermatology, Hospital Universitari Sagrat Cor, Barcelona, Spain
| | - Antoni Azon
- Department of Dermatology, Hospital Universitari Sant Joan de Reus, Reus, Spain
| | - Susana Bel-Pla
- Department of Dermatology, Hospital Comarcal d'Amposta, Amposta, Spain
| | - Xavier Bigata
- Department of Dermatology, Hospital de Mataró, Mataró, Spain
| | - Antoni Campoy
- Department of Dermatology, Hospital General de Catalunya, Sant Cugat, Spain
| | - Neus Curcó
- Department of Dermatology, Hospital Universitari Mútua Terrassa, Terrassa, Spain
| | - Joan Dalmau
- Department of Dermatology, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Manel Formigon
- Department of Dermatology, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Alberto Gonzalez
- Department of Dermatology, Consorci Sanitari Integral, L'Hospitalet de Llobregat, Spain
| | - Miquel Just
- Department of Dermatology, Hospital de Figueres, Figueres, Girona, Spain
| | - Enric Llistosella
- Department of Dermatology, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - M Elena Nogues
- Department of Dermatology, Hospital d'Igualada, Igualada, Barcelona, Spain
| | | | - Josep A Pujol
- Department of Dermatology, Hospital Universitari Joan XXIII, Tarragona, Spain
| | - Mireia Sabat
- Department of Dermatology, Hospital Parc Taulí, Sabadell, Spain
| | - Joan A Smandia
- Department of Dermatology, Hospital 2 de Maig, Barcelona, Spain
| | - Pedro Zaballos
- Department of Dermatology, Hospital de Santa Tecla, Tarragona, Spain
| | - Susana Puig
- Department of Dermatology, Hospital Clínic de Barcelona (Melanoma Unit), University of Barcelona, IDIBAPS, Barcelona & CIBERER, Barcelona, Spain
| | - Rosa M Martí
- Department of Dermatology, Hospital Universitari Arnau de Vilanova, University of Lleida, IRBLleida, Lleida & CIBERONC, Lleida, Spain
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11
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Duarte AF, Sousa-Pinto B, Barros AM, Haneke E, Correia O. Lentigo Maligna - Not Always a Face and Neck Disease of the Elderly. Dermatology 2018; 234:37-42. [PMID: 29895005 DOI: 10.1159/000489397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 04/17/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Lentigo maligna (LM) is a rare form of in situ melanoma, frequently seen as a large patch in elderly patients. The aim of this study was to assess clinical and dermoscopic features of LM. MATERIAL AND METHODS A retrospective study of LM patients presenting to our center between July 2007 and July 2017 was performed. Demographic data, anatomical location, laterality, diameter, Clark level, Breslow stage, "ABCD" signs and dermoscopic features were registered. Facial versus extrafacial LM were compared. RESULTS We found 21 LM, of which 12 had an extrafacial location and 9 a facial location. Half of the extrafacial lesions were located on an upper limb. The median age at diagnosis was 63 years (ranging from 38 to 84 years). Most LM cases were female (16/21) with phototype II (13/21). More than half of the patients (11/21) had a history of a skin neoplasm or actinic keratosis. The median diameter found was 6 mm (interquartile range = 4.5 mm), ranging from 1 to 15 mm. Five lesions were invasive (median Breslow depth of 0.2 mm), and 4 of them were extrafacial. DISCUSSION In this study LM was more frequently found in an extrafacial location and as a small patch with a 6-mm diameter medium. The epidemiology of LM/LM melanoma might be changing. Full body examination and dermoscopy are of the utmost importance for the diagnosis. Dermatologists should be aware and search for small lesions outside the face and neck, particularly in middle-aged female patients with photo-damaged skin.
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Affiliation(s)
- Ana Filipa Duarte
- Centro de Dermatologia Epidermis, Instituto CUF, Porto, Portugal.,MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Bernardo Sousa-Pinto
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal.,Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Eckart Haneke
- Centro de Dermatologia Epidermis, Instituto CUF, Porto, Portugal.,Department of Dermatology, Inselspital, University of Bern, Bern, Switzerland.,Dermatology Clinic Dermaticum, Freiburg, Germany.,Department of Dermatology, University of Ghent, Ghent, Belgium
| | - Osvaldo Correia
- Centro de Dermatologia Epidermis, Instituto CUF, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal.,Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
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12
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Helgadottir H, Rocha Trocoli Drakensjö I, Girnita A. Personalized Medicine in Malignant Melanoma: Towards Patient Tailored Treatment. Front Oncol 2018; 8:202. [PMID: 29946532 PMCID: PMC6006716 DOI: 10.3389/fonc.2018.00202] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/21/2018] [Indexed: 12/24/2022] Open
Abstract
Despite enormous international efforts, skin melanoma is still a major clinical challenge. Melanoma takes a top place among the most common cancer types and it has one of the most rapidly increasing incidences in many countries around the world. Until recent years, there have been limited options for effective systemic treatment of disseminated melanoma. However, lately, we have experienced a rapid advancement in the understanding of the biology and molecular background of the disease. This has led to new molecular classifications and the development of more effective targeted therapies adapted to distinct melanoma subtypes. Not only are these treatments more effective but they can be rationally prescribed to the patients standing to benefit. As such, melanoma management has now become one of the most developed for personalized medicine. The aim of the present paper is to summarize the current knowledge on melanoma molecular classification, predictive markers, combination therapies, as well as emerging new treatments.
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Affiliation(s)
- Hildur Helgadottir
- Skin Tumor Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden.,Cancer Centrum Karolinska, Karolinska Institutet Stockholm, Stockholm, Sweden
| | - Iara Rocha Trocoli Drakensjö
- Skin Tumor Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden.,Cancer Centrum Karolinska, Karolinska Institutet Stockholm, Stockholm, Sweden
| | - Ada Girnita
- Skin Tumor Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden.,Cancer Centrum Karolinska, Karolinska Institutet Stockholm, Stockholm, Sweden
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De Luca EV, Perino F, Di Stefani A, Coco V, Fossati B, Peris K. Lentigo maligna: diagnosis and treatment. GIORN ITAL DERMAT V 2018; 155:179-189. [PMID: 29683288 DOI: 10.23736/s0392-0488.18.06003-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Lentigo maligna (LM) is an in situ subtype of melanoma, clinically presenting as a pigmented, asymmetric macule that originates mostly on the head and neck and spreads slowly. The diagnosis may be challenging both for clinicians and pathologists. Dermatoscopy and reflectance confocal microscopy represent a useful tool in the differentiation of LM from other pigmented lesions, such as pigmented actinic keratosis, solar lentigines, seborrheic keratosis and lichen planus-like keratosis. Moreover, those non-invasive diagnostic technique may be crucial in the selection of optimal biopsy sites in equivocal lesions, in pre-surgical mapping and in evaluating and monitoring response to non-surgical treatments. Histologic examination remains the gold standard for the diagnosis of LM, showing a lentiginous proliferation of basal atypical melanocytes on a severe sun-damaged skin. The management of LM is constantly evolving. Treatments include surgery (the first choice, when available), radiotherapy and imiquimod cream (in patients not candidates to surgery). Many other possible treatments for LM have been tested, but they are not yet supported by strong evidences. We collected current guidelines and PubMed available reviews, studies and case-reports in order to make an overview on diagnosis and treatment of LM.
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Affiliation(s)
- Erika V De Luca
- Institute of Dermatology, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy -
| | - Francesca Perino
- Institute of Dermatology, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Alessandro Di Stefani
- Institute of Dermatology, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Valeria Coco
- Institute of Dermatology, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Barbara Fossati
- Institute of Dermatology, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Ketty Peris
- Institute of Dermatology, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
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Rivera A, Nan H, Li T, Qureshi A, Cho E. Alcohol Intake and Risk of Incident Melanoma: A Pooled Analysis of Three Prospective Studies in the United States. Cancer Epidemiol Biomarkers Prev 2016; 25:1550-1558. [PMID: 27909090 PMCID: PMC5137801 DOI: 10.1158/1055-9965.epi-16-0303] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 08/15/2016] [Accepted: 08/15/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Alcohol consumption is associated with increased risk of numerous cancers, but existing evidence for an association with melanoma is equivocal. No study has evaluated the association with different anatomic locations of melanoma. METHODS We used data from three large prospective cohort studies to investigate whether alcohol intake was associated with risk of melanoma. Alcohol intake was assessed repeatedly by food-frequency questionnaires. A Cox proportional hazards model was used to calculate multivariate-adjusted hazard ratios (HRs). RESULTS A total of 1,374 cases of invasive melanoma were documented during 3,855,706 person-years of follow-up. There was an association between higher alcohol intake and incidence of invasive melanoma (pooled multivariate HR 1.14 [95% confidence interval (CI), 1.00-1.29] per drink/day; Ptrend = 0.04). Among alcoholic beverages, white wine consumption was associated with an increased risk of melanoma (pooled multivariate HR 1.13 [95% CI, 1.04-1.24] per drink/day; Ptrend <0.01) after adjusting for other alcoholic beverages. The association between alcohol consumption and melanoma risk was stronger for melanoma in relatively UV-spared sites (trunk) versus more UV-exposed sites (head, neck, or extremities). Compared with nondrinkers, the pooled multivariate-adjusted HRs for ≥20 g/day of alcohol were 1.02 (95% CI, 0.64-1.62; Ptrend = 0.25) for melanomas of the head, neck, and extremities and 1.73 (95% CI, 1.25-2.38; Ptrend = 0.02) for melanomas of the trunk. CONCLUSIONS Alcohol intake was associated with a modest increase in the risk of melanoma, particularly in UV-protected sites. IMPACT These findings further support American Cancer Society Guidelines for Cancer Prevention to limit alcohol intake. Cancer Epidemiol Biomarkers Prev; 25(12); 1550-8. ©2016 AACR.
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Affiliation(s)
| | - Hongmei Nan
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | - Tricia Li
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Abrar Qureshi
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Eunyoung Cho
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
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Greveling K, Wakkee M, Nijsten T, van den Bos RR, Hollestein LM. Epidemiology of Lentigo Maligna and Lentigo Maligna Melanoma in the Netherlands, 1989-2013. J Invest Dermatol 2016; 136:1955-1960. [PMID: 27349862 DOI: 10.1016/j.jid.2016.06.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 04/26/2016] [Accepted: 06/15/2016] [Indexed: 12/25/2022]
Abstract
Lentigo maligna (LM) is considered a precursor to LM melanoma (LMM). We assessed trends in LM and LMM incidence rates between 1989 and 2013 in the Netherlands, and estimated the risk of an LMM after LM. Data on newly diagnosed LM and LMM were obtained from the Netherlands Cancer Registry and PALGA: Dutch Pathology Registry. Age-standardized incidence rates (European standardized rate), estimated annual percentage changes, and the cumulative incidence of LMM after LM were calculated. Between 1989 and 2013, 10,545 patients were diagnosed with a primary LM and 2,898 with a primary LMM in the Netherlands. The age-standardized incidence rate for LM increased from 0.72 to 3.84 per 100,000 person-years, and for LMM from 0.24 to 1.19 between 1989 and 2013. LM incidence increased from 2002 to 2013 with 6.8% annually, before an even steeper rise in LMM incidence from 2007 to 2013 (estimated annual percentage change: 12.4%). The cumulative incidence of LMM after a primary LM after 25-year follow-up was 2.0% for males and 2.6% for females. The increased incidence of LM and LMM in the Netherlands seems, besides increased awareness and increased histological confirmation of LM, to reflect a true increase. The absolute risk of an LMM (at any location) after a histologically confirmed LM was low (2.0-2.6%).
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Affiliation(s)
- Karin Greveling
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Marlies Wakkee
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Tamar Nijsten
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Renate R van den Bos
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Loes M Hollestein
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands; Department of Research, Netherlands Comprehensive Cancer Center, Utrecht, The Netherlands.
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Tiodorovic-Zivkovic D, Argenziano G, Lallas A, Thomas L, Ignjatovic A, Rabinovitz H, Moscarella E, Longo C, Hofmann-Wellenhof R, Zalaudek I. Age, gender, and topography influence the clinical and dermoscopic appearance of lentigo maligna. J Am Acad Dermatol 2015; 72:801-8. [DOI: 10.1016/j.jaad.2015.01.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 01/16/2015] [Accepted: 01/19/2015] [Indexed: 12/17/2022]
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Evaluation of the role of routine melan-A immunohistochemistry for exclusion of microinvasion in 120 cases of lentigo maligna. Am J Dermatopathol 2014; 36:387-91. [PMID: 24394300 DOI: 10.1097/dad.0b013e3182a3877a] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND To assess the usefulness of routine melan-A immunohistochemistry (IHC) for exclusion of microinvasion in lentigo maligna (LM). METHODS One hundred and twenty cases of LM from our archives were reviewed by 2 authors with S100 protein and melan-A IHC using a red chromogen. RESULTS Melan-A was useful to confirm the diagnosis of LM in early lesions and to differentiate these from chronically sun-damaged skin. The presence of scattered melan-A-positive cells was noted in the dermis in 72 of 120 cases (melanophages in 36 cases, nonspecific cells different to melanophages in 16 cases, and a dual cell population in 20 cases). The significance of these cells was uncertain. Only 3 cases suspicious for microinvasion were identified: 2 on haematoxylin and eosin and 1 on S100. CONCLUSIONS We recommend use of melan-A to confirm the diagnosis in early lesions of LM and in the differential diagnosis from melanocytic hyperplasia in chronically sun-exposed skin. We do not recommend routine use of melan-A to identify or exclude microinvasion. However, it may have a role, in conjunction with S100, in cases with suspicious features for early invasion on haematoxylin and eosin sections.
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Moscarella E, Kyrgidis A, Sperduti I, Abramavicus A, Argenziano G, Cota C, Eibenschutz L, De Simone P, Longo C, Hofmann-Wellenhof R, Zalaudek I. Age-related prevalence and morphological appearance of facial skin tumours: a prospective, cross-sectional, observational, multicentre study with special emphasis on melanocytic tumours. J Eur Acad Dermatol Venereol 2014; 29:1331-8. [DOI: 10.1111/jdv.12844] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Accepted: 10/13/2014] [Indexed: 11/30/2022]
Affiliation(s)
- E. Moscarella
- Dermatology and Skin Cancer Unit; 1st Medical Department; Arcispedale Santa Maria Nuova; IRCCS; Reggio Emilia Italy
| | - A. Kyrgidis
- Dermatology and Skin Cancer Unit; 1st Medical Department; Arcispedale Santa Maria Nuova; IRCCS; Reggio Emilia Italy
| | - I. Sperduti
- Biostatistical Unit; Regina Elena National Cancer Institute; Rome Italy
| | - A. Abramavicus
- Dermatology and Skin Cancer Unit; 1st Medical Department; Arcispedale Santa Maria Nuova; IRCCS; Reggio Emilia Italy
| | - G. Argenziano
- Dermatology and Skin Cancer Unit; 1st Medical Department; Arcispedale Santa Maria Nuova; IRCCS; Reggio Emilia Italy
| | - C. Cota
- Dermatopathology Unit; San Gallicano Dermatological Institute; IRCCS; Rome Italy
| | - L. Eibenschutz
- Oncologic Dermatology; San Gallicano Dermatological Institute; IRCCS; Rome Italy
| | - P. De Simone
- Oncologic Dermatology; San Gallicano Dermatological Institute; IRCCS; Rome Italy
| | - C. Longo
- Dermatology and Skin Cancer Unit; 1st Medical Department; Arcispedale Santa Maria Nuova; IRCCS; Reggio Emilia Italy
| | - R. Hofmann-Wellenhof
- Department of Dermatology and Venerology; Medical University of Graz; Graz Austria
| | - I. Zalaudek
- Department of Dermatology and Venerology; Medical University of Graz; Graz Austria
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A model for lentigo maligna recurrence using melanocyte count as a predictive marker based upon logistic regression analysis of a blinded retrospective review. J Plast Reconstr Aesthet Surg 2014; 67:1322-32. [DOI: 10.1016/j.bjps.2014.05.058] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 05/26/2014] [Accepted: 05/27/2014] [Indexed: 11/24/2022]
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Tsakok T, Sheth N, Robson A, Gleeson C, Mallipeddi R. Lentigo maligna mimicking invasive melanoma in Mohs surgery: a case report. F1000Res 2014; 3:25. [PMID: 25075285 PMCID: PMC4097356 DOI: 10.12688/f1000research.3-25.v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/15/2014] [Indexed: 12/26/2022] Open
Abstract
Lentigo maligna is a lentiginous proliferation of atypical melanocytes confined to the epidermis, typically on chronically sun-damaged skin. Following biopsy and exclusion of invasive disease, therapy may involve Mohs surgery, topical treatment or radiotherapy. However, lentigo maligna often involves adnexal structures, creating histological difficulty in distinguishing these foci from invasive melanoma. We present a case in which, during Mohs excision, a nodule of severely atypical melanocytes appeared to lie within the dermis, potentially altering treatment and prognosis. The use of laminin-5 provided a means of resolving this diagnostic dilemma, facilitating continuation of Mohs surgery until tumour clearance was achieved.
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Affiliation(s)
- Teresa Tsakok
- Dermatological Surgery and Laser Unit, St John's Institute of Dermatology, St Thomas' Hospital, London, UK
| | - Nisith Sheth
- Dermatological Surgery and Laser Unit, St John's Institute of Dermatology, St Thomas' Hospital, London, UK
| | - Alistair Robson
- Dermatological Surgery and Laser Unit, St John's Institute of Dermatology, St Thomas' Hospital, London, UK
| | - Catherine Gleeson
- Dermatological Surgery and Laser Unit, St John's Institute of Dermatology, St Thomas' Hospital, London, UK
| | - Raj Mallipeddi
- Dermatological Surgery and Laser Unit, St John's Institute of Dermatology, St Thomas' Hospital, London, UK
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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] [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.
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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.
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Shiau CJ, Thompson JF, Scolyer RA. Controversies and evolving concepts in the diagnosis, classification and management of lentigo maligna. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/edm.13.17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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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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Pralong P, Bathelier E, Dalle S, Poulalhon N, Debarbieux S, Thomas L. Dermoscopy of lentigo maligna melanoma: report of 125 cases. Br J Dermatol 2012; 167:280-7. [DOI: 10.1111/j.1365-2133.2012.10932.x] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Stricklin SM, Stoecker WV, Malters JM, Drugge R, Oliviero M, Rabinovitz HS, Perry LA. Melanoma in situ in a private practice setting 2005 through 2009: location, lesion size, lack of concern. J Am Acad Dermatol 2012; 67:e105-9. [PMID: 22226813 DOI: 10.1016/j.jaad.2011.11.949] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 11/22/2011] [Accepted: 11/30/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Studies have shown that the incidence of melanoma in situ (MIS) is increasing significantly. OBJECTIVE This study analyzes selected clinical and demographic characteristics of MIS cases observed in private dermatology practices in the United States. METHODS This study collected 257 MIS cases from 4 private dermatology practices in the United States from January 2005 through December 2009, recording age, gender, anatomic location, lesion size, patient-reported change in lesion, and concern about lesion. Case totals for invasive melanoma during the same period were recorded. RESULTS The data collected showed a higher incidence of MIS in sun-exposed areas of older patients, especially men. The median age of patients at the time of MIS detection was 69 years. The most common site for MIS was the head-neck region. The number of MIS cases collected exceeded the number of invasive malignant melanoma cases during the study period, with an observed ratio of 1.35:1. LIMITATIONS For 136 patients, data were collected retrospectively for lesion size, location, gender, and age. For these patients, patient-reported change in lesion and concern about lesion were not collected. Patients often did not consent to a full body examination, therefore, it is possible that MIS lesions may have been missed in double-clothed areas. CONCLUSION Careful attention to pigmented lesions, even lesions less than 4 mm, on sun-exposed areas, including scalp, trunk, and feet, will facilitate earlier diagnosis of MIS. As only 30.4% of male patients and 50% of female patients had concern about these lesions, it still falls to the dermatologist to discover MIS.
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Goodson AG, Florell SR, Boucher KM, Grossman D. A decade of melanomas: identification of factors associated with delayed detection in an academic group practice. Dermatol Surg 2011; 37:1620-30. [PMID: 21790849 DOI: 10.1111/j.1524-4725.2011.02097.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Melanoma incidence is increasing, but the effect of various clinical factors on tumor stage is unclear. OBJECTIVE To review histologic and clinical features of melanomas diagnosed in our group over a 10-year period to determine trends in diagnosis and lesion derivation, predictive value of clinical lesion size, and effect of physician and patient concerns before biopsy. METHOD Relevant pathology reports and physician clinic notes were reviewed for 572 melanomas. RESULT From 1999 to 2008, melanoma biopsies increased significantly more than nevus biopsies and patient visits. Melanomas predominantly (81%) arose de novo, with remaining lesions as likely to arise from common as dysplastic nevi. Melanomas were detected at twice the rate, and at earlier stage, in established as in new patients. Clinical size of invasive melanomas was related to lesion depth. For 64% of melanomas, patient and physician concern drove the decision to biopsy, whereas 1.4% of melanomas were biopsied only for patient concern. CONCLUSION The increase in melanoma diagnoses was largely due to increases in cases of lentigo maligna on the head and neck. Delayed detection was associated with location on trunk and extremities, new patient status, patient concern before biopsy, and physician suspicion of nonmelanoma skin cancer.
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Affiliation(s)
- Agnessa Gadeliya Goodson
- Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City, Utah 84112, USA
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NADIMINTI HARI, SCOPE ALON, MARGHOOB ASHFAQA, BUSAM KLAUS, NEHAL KISHWERS. Use of Reflectance Confocal Microscopy to Monitor Response of Lentigo Maligna to Nonsurgical Treatment. Dermatol Surg 2010; 36:177-84. [DOI: 10.1111/j.1524-4725.2009.01421.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Skin cancers may be derived from any part of the skin, and the classification of all variants is extensive. Overall they are the most common cancers of the body, and include those that are highly mortal and those that are associated with an increased morbidity. In this review the most common skin cancers confronted by the clinician and their management are discussed. New associations are highlighted, as well as new information that can help the clinician to better understand the pathogenesis of many of these entities.
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Affiliation(s)
- Carlos Ricotti
- Department of Dermatology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9069, USA
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