DERMATOSCOPY OF LENTIGO MALIGNA - 03/09/11

Doi : 10.1016/S0733-8635(05)70268-0

Armand B. Cognetta, MD ^a, Wilhelm Stolz, MD ^c, Brian Katz, BA ^b, Julie Tullos, BS ^a, Sunita Gossain, MBBS, MRCP ^d

^a Dermatology Associates, Tallahassee (ABC, JT)

^b Skin and Cancer Associates, Plantation (BK), Florida

^c Department of Dermatology, University of Regensburg, Regensburg, Germany (WS)

^d Medical College of London University, London, United Kingdom (SG)

Résumé

Lentigo maligna (LM) may be defined as malignant melanoma in situ arising in sun-damaged skin.^{27 Stonecipher MR, Leshin B, Patrick J, et al: The management of lentigo and lentigo maligna melanoma with paraffin embedded tangential sections. J Am Acad Dermatol 29:589–594

Cliquez ici pour aller à la section Références} Most lesions occur on the faces of older persons who have sun-damaged skin. LM was first described by Hutchinson in 1890 and hence the name Hutchinson's melanocytic freckle.^{12 Hutchinson J. Lentigo-melanosis: A further report Arch Surg 1894 ; 5 : 253-256

Cliquez ici pour aller à la section Références} He considered these lesions infective in nature because of their slow growth and termed them “infective senile freckles”. In 1894, Dubreulih^{9 Dudreulih M.W. Lentigo malin des veiillards Ann Dermatol Syphilis 1984 ; 5 : 1092-1099

Cliquez ici pour aller à la section Références} reported four cases of “malignant lentigo of the elderly.” In 1912, he further characterized this lesion as “circumscribed precancerous melanosis.” Currently, these lesions generally are referred to as LM when confined to the epidermis and lentigo maligna melanoma (LMM) when invasive.^{4 Becker S.W. Critical evaluation of the so-called “junctional naevus.” J Invest Dermatol 1954 ; 22 : 217-223 [cross-ref]

Cliquez ici pour aller à la section Références, 21 Sach W., MacKee G.M. , et al. Junction naevus: Nevocarcinoma JAMA 1947 ; 135 : 216-218

Cliquez ici pour aller à la section Références}

Clinically, LM lesions are flat, pigmented skin lesions usually found in older persons who have a history of actinic damage. LM lesions are commonly located on the head and neck region and most frequently on the cheek.^{19 Newell G.R., Sider J.G., Bergfelt L. , et al. Incidence of cutaneous melanoma in the United States by histology with special reference to the face Cancer Res 1988 ; 48 : 5036-5041

Cliquez ici pour aller à la section Références, 28 Pitman G.H., Kopf A.W., Bart R.S. , et al. Treatment of lentigo maligna and lentigo maligna melanoma Journal of Dermatology and Surgical Oncology 1979 ; 5 : 727-737

Cliquez ici pour aller à la section Références} Generally, LM lesions grow slowly in a horizontal direction and, if left untreated, may progress to LMM with a propensity to metastasize.

The histologic diagnosis of LM is established by the presence of atypical melanocytes partially replacing the basal layer of the epidermis, with no evidence of dermal invasion. The use of star-burst giant cells as well as a biopsy of the contralateral skin for comparison of baseline melanocyte and morphology has been described by Cohen et al^{7 Cohen Lentigo maligna, lentigo maligna melanomas J Am Acad Dermatol 1996 ; 35 : 962-1008 [cross-ref]

Cliquez ici pour aller à la section Références} and represents the preinvasive form of malignant melanoma.

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Plan

INCIDENCE

CAUSES

CLINICAL CHARACTERISTICS

CLINICAL COURSE

DIAGNOSTIC ACCURACY

DERMATOSCOPY FEATURES

CLINICAL PATHOLOGIC CORRELATIONS OF DERMATOSCOPY OF THE FACE

SUMMARY

Address reprint requests to Armand B. Cognetta, Jr, MD 1707 Riggins Road Tallahassee, FL 32308
This work was supported in part by Grant No. 15.12.60 from the Istituto Oncologico Romagnolo, Forli, Italy