Lentigo Maligna One Size Does Not Fit All

Archives of dermatology (Impact Factor: 4.79). 10/2011; 147(10):1211-3. DOI: 10.1001/archdermatol.2011.234
Source: PubMed
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    ABSTRACT: Although new technologies are becoming available to aid in diagnosis, the skin biopsy continues to be the fundamental tool of the dermatologist to evaluate the nature of a pigmented lesion. There are 3 major techniques for the biopsy of a pigmented lesion: shave biopsy, punch/incisional biopsy, and excisional biopsy. This article discusses when to biopsy a pigmented lesion and reviews the different biopsy techniques, with reference to specific clinical scenarios.
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    ABSTRACT: Lentigo maligna is a type of in situ melanoma. It develops mainly in middle-aged and elderly individuals on areas of the skin chronically exposed to sunlight. It progresses to its invasive form, lentigo maligna melanoma, in 5% to 50% of cases. Management of lentigo maligna is open to debate, with a notable lack of randomized trials and specific guidelines and protocols. Early diagnosis and treatment is necessary to achieve cure if possible and prevent progression to invasive melanoma with the corresponding risk of metastasis. The treatment of choice for lentigo maligna is surgery. When surgery is not possible, other alternatives are available although outcomes and rates of recurrence are variable. The objective of this study was to review the diagnostic methods and criteria for lentigo maligna, as well as the different surgical options and alternatives to surgery, in order to provide information on the best approach in each case.
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    ABSTRACT: The diagnosis of lentigo maligna (LM) is often challenging for both clinicians and pathologists. LM is widely regarded as a form of melanoma in situ occurring in severely sun-damaged skin with characteristic clinical and pathologic features. However, compared with other forms of in situ melanoma, it often has a long-term clinical course for evolution to invasive melanoma. Some authorities advocate dividing LM into premalignant/precursor and in situ melanoma (LM in situ melanoma) phases, implying a lesser risk of the former for developing invasive melanoma. However, this subtle morphologic distinction does not necessarily correlate well with clinical outcome. An initial tissue sample for histologic diagnosis is commonly a small proportion of the lesion and may not be representative/diagnostic of LM. New clinical diagnostic tools including dermoscopy and in vivo confocal microscopy have improved the accuracy of both clinical diagnosis of LM and also defining the peripheral extent of the lesion for definitive treatment. In this review, the authors discuss these challenges and controversies in LM and provide recommendations for clinicopathologic diagnosis and management.
    Expert Review of Dermatology 04/2013; 8(2-2):195-214. DOI:10.1586/edm.13.17
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