Presentation
Lentigo maligna presents as a flat macule with geographic shape with coloration from tan to brown to black. [medicine.uiowa.edu]
This presented a significant interpretational problem. [f1000research.com]
Clinically, it presents as a slow-growing, asymmetric macule with irregular, poorly-defined borders and varied pigmentation. Areas of partial regression within the lesion are not uncommon. [ijdvl.com]
[…] the face, presenting as a single large evolving pigmented lesion with changing color. ( With permission from Usatine RP, Moy RL, Tobinick EL, Siegel DM. [accessmedicine.mhmedical.com]
A case is presented demonstrating the features of this malignant melanoma with an exceptionally good prognosis. The importance of the clinical and histologic correlation is emphasized to ensure proper diagnosis and treatment. [journals.sagepub.com]
Entire Body System
- Pathologist
[…] numerous other Hutchinson named entities including: Hutchinson triad Hutchinson pupil Hutchinson teeth Hutchinson sign Hutchinson syndrome History and etymology It is named after Sir Jonathan Hutchinson (1828-1913), English surgeon, ophthalmologist and pathologist [radiopaedia.org]
Even though excisional biopsy (removing the entire lesion) is ideal, and advocated by pathologists; practical reason dictates that this should not be done. These tumors are often large and presenting on the facial area. [en.wikipedia.org]
But in slow Mohs, rush permanent sections are sent off to the pathologist rather than the frozen sections integral to conventional Mohs. Dr. [mdedge.com]
General pathologists, who service the skin pathology for most family physicians, would have even more difficulty making an accurate diagnosis in this scenario. Furthermore, the ugliest part of a pigmented lesion may not be the most diagnostic. [aafp.org]
Pathology report in melanoma The pathologist's report should include a macroscopic description of the specimen and melanoma (the naked eye view), and a microscopic description. The following features should be reported if there is invasive melanoma. [dermnetnz.org]
- Fishing
If levels are reduced or deficient they may wish to consider taking supplementary vitamin D3, 10-25 micrograms per day, and increasing their intake of foods high in vitamin D such as oily fish, eggs, meat, fortified margarines and cereals. [cuh.nhs.uk]
If levels are reduced or deficient they may wish to consider taking supplementary Vitamin D3, 10-25 micrograms per day, and increasing their intake of foods high in Vitamin D such as oily fish, eggs, meat, fortified margarines and cereals. [yeovilhospital.co.uk]
If levels are reduced or deficient they may wish to consider taking supplementary vitamin D3, 10-25 micrograms per day, and increasing their intake of foods high in Vitamin D such as oily fish, eggs, meat, fortified margarines and cereals. [skinsupport.org.uk]
- Outdoor Worker
Thus lentigo maligna is more common in outdoor workers, in older people and in association with solar damage and keratinocyte skin cancer (basal cell carcinoma, squamous cell carcinoma). [dermnetnz.org]
Skin
- Freckles
It is also known as "Hutchinson's melanotic freckle". [3] This is named for Jonathan Hutchinson. [4] [5] The word lentiginous comes from the latin for freckle. Signs and symptoms [ edit ] Characteristics include a blue/black stain of skin initially. [en.wikipedia.org]
Also known as… Hutchinson’s Melanotic Freckle What is Lentigo Maligna? Lentigo maligna is an early form of melanoma. In lentigo maligna the cancer cells are confined to the upper layer of the skin (epidermis). [dermcoll.edu.au]
It can be hard to tell lentigo maligna melanoma from a freckle or age spot by looking at it. To help, you can use a trick known as the “ABCDEs” of skin cancer. [healthline.com]
Lentigo maligna, also known as Hutchinson freckle, is a non-familial precursor to lentigo maligna melanoma, which accounts for 5-15% of cases of malignant melanoma. It is most frequent in the head and neck. [radiopaedia.org]
Definition / general Atypical melanocytes in basal layer, individually and in nests (theques), associated with sun damage ( eMedicine ) Terminology Also called melanoma arising in Hutchinson freckle, actinic melanosis, melanoma on sun damaged skin and [pathologyoutlines.com]
- Skin Lesion
Skin lesion, forehead Show diagnosis & comments Diagnosis: Lentigo maligna melanoma Comments: Any invasive melanoma associated with lentigo maligna is classified as lentigo maligna melanoma. [melanocytepathology.com]
These lines are often polygonal, forming a zig-zag pattern lines angulated or polygonal (non-facial skin). Dermoscopy The examination of [skin lesions] with a 'dermatoscope'. [dermoscopedia.org]
Slideshow: What Your Skin Says About Your Health Slideshow: Adult Skin Problems: Pictures of Psoriasis, Rosacea, Skin Tags, and More Slideshow: Precancerous Skin Lesions and Skin Cancer Slideshow: Sun-Damaged Skin: Sunburn, Melanoma and Other Reasons [webmd.com]
Recognizing neoplastic skin lesions: a photo guide. Am Fam Physician. 1998;58:873–84. in reply : I am pleased that my article has provoked some constructive feedback. [aafp.org]
[…] types of skin lesion may appear rather similar to lentigo maligna. [dermnetnz.org]
- Keratosis
Other differential diagnoses include pigmented actinic keratosis Actinic keratosis (also called solar keratosis and senile keratosis; abbreviated as AK) is a pre-cancerous patch of thick, scaly, or crusty skin., lichen plaunus-like keratosis, and early [dermoscopedia.org]
With such lesions, the differential diagnosis includes solar lentigo (flat seborrheic keratosis), pigmented actinic keratosis and lichenoid keratosis. [1] Dermoscopy has been demonstrated to be an efficient technique that helps the dermatologist to distinguish [ijdvl.com]
The differential diagnosis includes seborrheic keratosis, pigmented actinic keratosis, and pigmented nevus. Lentigo maligna becomes lentigo maligna melanoma when malignant melanoma cells invade the dermis and deeper appendages. [mdedge.com]
lichen planus-like keratosis (LPLK), and pigmented actinic keratosis. [statpearls.com]
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. [karger.com]
- Papule
With time, LMM may develop invasive foci clinically evident as papules, nodules, or thicker plaques. LMM at that stage confers risk of metastatic disease This glossary term has not yet been described.. [dermoscopedia.org]
[…] as an early sign of LM.27 Because of this slow growth and sometimes hypomelanotic presentation, it is not uncommon that LM/LMM diagnosis is delayed, with 48.8% of lesions being >10mm in diameter at the time of biopsy.23 With time, LM may evolve into papules [dovepress.com]
Neurologic
- Burning Sensation
Local inflammatory side-effects (redness, burning sensation and erosions) frequently develop, and may cause burden to the patient; however, inflammation seems to be associated with the efficacy of treatment (64). [spandidos-publications.com]
Treatment
A systematic review of non-surgical treatments for lentigo maligna. [wiki.cancer.org.au]
The treatment of LM with Imiquimod is off-label. A few case reports and small case series exist for other topic treatment modalities such as ingenol mebutate, 5-fluorouracil and topical retinoids. [thieme-connect.com]
Other treatment modalities for LM have been studied but none of them still has proved to be efficient enough. Recently, photodynamic treatment (PDT) has been suggested as a promising novel treatment method for LM. [clinicaltrials.gov]
Non-surgical treatment options include the following. Radiotherapy (RT) RT has been used for decades for the treatment of MM, including LM, although nowadays it is not considered as the primary treatment option. [spandidos-publications.com]
Radiotherapy, cryotherapy, or topical treatments are options, although as with any melanoma treatment, the surgical removal of lentigo maligna is preferred and sensible with the latest techniques. [skincarenetwork.co.uk]
Prognosis
[…] is correlated with presence and depth of invasion, mitotic rate among invasive cells and presence / absence of ulceration Prognosis is excellent if noninvasive and completely excised Treatments: excision (gold standard), adjuvant topical therapies and [pathologyoutlines.com]
A case is presented demonstrating the features of this malignant melanoma with an exceptionally good prognosis. The importance of the clinical and histologic correlation is emphasized to ensure proper diagnosis and treatment. [journals.sagepub.com]
Lentigo maligna has a good prognosis when detected early and treated appropriately. However, a small percentage of lesions may be undetected and progress to become an invasive melanoma which is potentially life-threatening. [dermcoll.edu.au]
The prognosis is generally better than for other types of melanomas, reflecting the differences in tumour thickness 1 LeBoit PE, Burg G, Weedon D, Sarasin A (Eds.) World Health Organization Classification of Tumours. [codes.iarc.fr]
Prognosis The prognosis for LM/LMM excellent. [statpearls.com]
Etiology
Acquisition of oncogenic genetic mutations by chronic ultraviolet light exposure (Annu Rev Pathol 2014;9:239) Flat, spreading, pigmented radial growth phase eventually gives rise to invasive, tumorigenic vertical growth phase with metastatic potential Etiology [pathologyoutlines.com]
Solar radiation in the etiology of cutaneous malignant melanoma in Caucasians. Natl Cancer Inst Monogr. 1982;62:167-71. [PubMed: 7167183] 9. Holman CD, Armstrong BK. [ncbi.nlm.nih.gov]
Etiology The major risk factor for development of LM/LMM is ultraviolet radiation (UVR), in particular cumulative lifetime UVR exposure. [6] [7] [8] [9] Several studies have demonstrated that LM/LMM is strongly associated with chronic UVR exposure, as [statpearls.com]
For more information, see the following Etiology and Pathophysiology Risk factors for lentigo maligna melanoma include the following: Ultraviolet radiation exposure: For people who live in Australia, the risk increases as the number of years spent in [emedicine.medscape.com]
Epidemiology
The PRISMA (Preferred Reporting Itens for Systematic Reviews and Meta-Analyses) and MOOSE (Meta-analysis Of Observational Studies in Epidemiology) guidelines were followed for data extraction. [dovepress.com]
The epidemiology of LM/LM melanoma might be changing. Full body examination and dermoscopy are of the utmost importance for the diagnosis. [karger.com]
Epidemiology, screening, and clinical features. J Am Acad Dermatol. 2015 Aug;73(2):181-90, quiz 191-2. [PubMed: 26183967] 25. Buettner PG, Leiter U, Eigentler TK, Garbe C. [ncbi.nlm.nih.gov]
[…] 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 [pubmed.ncbi.nlm.nih.gov]
Melasma: Epidemiology, pathogenesis, clinical presentation, and diagnosis. https://www.uptodate.com/contents/search. Accessed Nov. 24, 2020. Wolff K, et al. Photosensitivity, photo-induced disorders and disorders by ionizing radiation. [mayoclinic.org]
Pathophysiology
[…] melanoma of skin, unspecified Epidemiology Older patients, usually over 50 (Annu Rev Pathol 2014;9:239) Develops at sites of chronic, continuous, cumulative sun exposure Sites Face, neck, ears, scalp (if not shielded by hair), forearms, dorsal hands Pathophysiology [pathologyoutlines.com]
[…] between 1990-2000. [18] It is unclear whether these data represent true increases in incidence or improved diagnosis. [24] The faster rise in incidence of MIS compared to invasive melanoma suggests that detection bias plays some role at least. [25] Pathophysiology [statpearls.com]
For more information, see the following Etiology and Pathophysiology Risk factors for lentigo maligna melanoma include the following: Ultraviolet radiation exposure: For people who live in Australia, the risk increases as the number of years spent in [emedicine.medscape.com]
[…] between 1990 to 2000.[18] It is unclear whether these data represent true increases in incidence or improved diagnosis.[24] The faster rise in the incidence of MIS compared to invasive melanoma suggests that detection bias plays some role at least.[25] Pathophysiology [ncbi.nlm.nih.gov]
Prevention
Knowing these risk factors may help you and your doctor discuss steps for cancer prevention. [cancercenter.com]
Lentigo maligna melanoma is more likely to return than some other types of skin cancer, so your doctor may also remove some of the skin surrounding the spot to prevent this. [healthline.com]
The goals of treatment are to: cure the cancer preserve the appearance of your skin prevent the cancer from coming back The extent and depth of the melanoma guides your care plan. [mskcc.org]
Most people who have had a lentigo maligna, or melanoma in situ, removed will need another operation to try to prevent the melanoma from coming back at the original site. [esms-mohs.eu]
NG14/2 Question Surgical excision for people with lentigo maligna:- For people with lentigo maligna (stage 0 in sun-damaged skin, usually on the face) how effective is Mohs micrographic surgery, compared with excision with a 0.5 cm clinical margin, in preventing [nice.org.uk]