Lentiginous melanoma: A distinctive clinicopathological entity

Histopathology (Impact Factor: 3.45). 04/2008; 52(4):523-5. DOI: 10.1111/j.1365-2559.2008.02943.x
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    • "In the present study, most diagnostic changes occurred in D2 (with the knowledge of the age and the sex of the patient and of the location of the lesion). The low number of diagnostic changes does not allow to draw any reliable conclusion, but we roughly assess that there are at least three types of melanocytic lesions which are particularly sensitive to clinical information, namely, lentiginous melanocytic proliferations [19], Spitz/Reed nevus-like neoplasms [4], [7], [18], and congenital nevi with atypical features. "
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    ABSTRACT: We tested the relevance of clinical information in the histopathologic evaluation of melanocytic skin neoplasm (MSN). Histopathologic specimens from 99 clinically atypical MSN were circulated among ten histopathologists; each case had clinical information available in a database with a five-step procedure (no information; age/sex/location; clinical diagnosis; clinical image; dermoscopic image); each step had a histopathologic diagnosis (D1 through D5); each diagnostic step had a level of diagnostic confidence (LDC) ranging from 1 (no diagnostic certainty) to 5 (absolute diagnostic certainty). The comparison of the LDC was employed with an analysis of variance (ANOVA) for repeated measures. In D1 (no information), 36/99 cases (36.3%) had unanimous diagnosis; in D5 (full information available), 51/99 cases (51.5%) had unanimous diagnosis (p for difference between proportions <0.001). The observer agreement expressed as kappa increased significantly from D1 to D5. The mean LDC linearly increased for each observer from D1 through D5 (p for linear trend <0.001). On average, each histopathologist changed his initial diagnosis in 7 cases (range: 2-23). Most diagnostic changes were in D2 (age/sex/location). The histopathologic criteria for the diagnosis of MSN can work as such, but the final histopathologic diagnosis is a clinically-aided interpretation. Clinical data sometimes reverse the initial histopathologic evaluation.
    PLoS ONE 06/2009; 4(4):e5375. DOI:10.1371/journal.pone.0005375 · 3.23 Impact Factor
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    Expert Review of Dermatology 10/2008; 3(5):529-533. DOI:10.1586/17469872.3.5.529
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    ABSTRACT: Lentigo maligna (LM) is a cutaneous malignancy with increasing incidence and significant risk of morbidity. Early diagnosis of LM requires a high index of suspicion for the often subtle atypical signs of pigmented lesions on sun-damaged skin. A variety of treatment options are available to the physician. Surgical options include simple excision and margin-control techniques such as staged excision and Mohs micrographic surgery. Tissue may be embedded vertically or en face, and processed as frozen or paraffin-embedded sections. Destructive options include radiotherapy, cryotherapy, curettage, and electro-destruction. Topical therapy may be appropriate in selected cases; immunotherapy with topical imiquimod may have advantages over other topical agents. The opportunity for curative therapy is maximized by surgical treatment. Margin-control surgery offers the highest cure rate while minimizing loss of normal tissue.
    Giornale Italiano di Dermatologia e Venereologia 05/2009; 144(2):149-55. · 0.68 Impact Factor
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