Melanoma: clinical, evolutive and histopathological characteristics of a series of 136 cases

Abstract: BACKGROUND: The incidence of melanoma has been increasing in Brazil and all over the world. Despite improvements in diagnosis and treatment, mortality remains unchanged. OBJECTIVE: To associate clinical and histopathological aspects with the evolution of 136 cases of cutaneous melanoma. METHODS: Retrospective cohort study that analyzed all patients diagnosed with melanoma during the period from 2003 to 2011, with at least 4 years follow up. Archived slides were analyzed to study histopathological variables (Breslow, ulceration, mitoses and histological regression). Medical records were used to retrieve clinical variables (age, sex, localization, time of appearance, diameter) and progression (metastases or death). Association measures were assessed by statistical analysis. RESULTS: There was no statistically significant difference between groups according to age. Superficial spreading subtype showed lower Breslow (0.5mm) than acral lentiginous and nodular subtypes (2 and 4.6mm respectively), less ulceration and metastases (9.4% against 50 and 70.6%). Nodular subtype had higher mitoses' median (5.0/mm2) than superficial spreading and lentigo maligna (0.0/mm2, for both). Regression was more frequent in superficial spreading and lentigo maligna subtypes. There were only deaths by melanoma in the acral group, however, there were deaths for other reasons in groups superficial spreading one, acral lentiginous one and lentigo maligna two. STUDY LIMITATIONS: Use of medical records as a source of data to the study. CONCLUSIONS: Superficial spreading subtype presents better prognosis indicators. Histological subtype should be considered in follow-up and treatment protocols of patients with cutaneous melanoma.

Synchronous conjunctival melanoma and lentigo maligna melanoma

Abstract: Lentigo maligna has an extensive and neoplastic character. It typically progresses slowly and may eventually develop into an invasive melanoma, which is called lentigo maligna melanoma. Ocular melanoma is the second most common type of melanoma. The uvea is the most common site of origin of ocular melanomas, while conjunctival melanoma accounts for about 1-5% of cases. In this article, we describe a rare case of synchronic conjunctival melanoma and lentigo maligna on the face.

Lentigo maligno na face: um desafio na conduta / Lentigo maligna on the face: a challenging conduct

Resumo O lentigo maligno é um melanoma in situ, de crescimento radial e lento, que acomete áreas fotoexpostas principalmente em idosos. Quando acomete a pálpebra, devido à proximidade a um órgão nobre, a conduta é controversa, porém a cirurgia é o método mais usado, com margens que variam de acordo com a referência utilizada. Terapias conservadoras são descritas, como o imiquimode 5% e a radioterapia. O presente relato tem como objetivo demonstrar a escassez de estudos sobre a margem cirúrgica e citar opções de tratamentos não cirúrgicos para o lentigo maligno da face.

Abstract Lentigo maligna is a melanoma in situ, of slow radial growth, which affects sun-exposed areas, especially in the elderly. When it affects the eyelid, due to the proximity to a noble organ, the conduct is controversial, but surgery is the method most commonly used, with with margins varying according to the reference used. Conservative treatments are described, such as imiquimod 5% and radiotherapy. This report aims to demonstrate the lack of studies on the surgical margin, and to name nonsurgical treatment options for lentigo maligna of the face.

Dermoscopic and clinical features of head and neck melanoma

AbstractBACKGROUND:The dermoscopic criteria of extrafacial melanomas are well-known.OBJECTIVE:To determine the frequency of dermatoscopic findings in head and neck melanomas (HNM) and to assess the distinguishing dermoscopic criteria of facial and extrafacial melanoma.METHODS:This observational study included 108 patients with HNM (63% male, mean age 64 years). Participants underwent individual dermoscopic imaging of clinically melanoma. All lesions were excised, and histopathological examination was performed on all specimens.RESULTS:Drawing on histopathological analysis, lentigo maligna melanoma or lentigo maligna was diagnosed in 60 lesions, superficial spreading melanoma in 18, nodular in 10, desmoplastic in 8, superficial spreading melanoma in situ in 12. The most frequent location for head and neck melanoma was the cheek (60 patients, 55.6%). Eight prominent dermatoscopic features were observed in facial melanoma: annular-granular pattern (18%); rhomboidal structures (29%); pseudonetwork (29%); asymmetrical, pigmented, follicular openings (51%); obliterated hair follicles (8%); red rhomboidal structures (18%); increased density of the vascular network (32%); scar-like depigmentation (59%).CONCLUSIONS:HNM has specific dermoscopic features, and classical extrafacial dermoscopic rules are less useful for diagnosis of facial melanoma. In our study, further characteristic dermatoscopic findings were detected in facial melanoma such as low frequencies of irregular dots, 2 or fewer colors in lesions, the presence of pseudonetwork, increased density of the vascular network, red rhomboidal structures, in addition to dermatoscopic findings of extrafacial melanoma. Thus, it is concluded that the prediction and identification of HNM may be evident with the help of these signs.

Contoured technique for lentigo maligna

The surgical approach to lentigo maligna is a challenge to dermatologists, given the difficulty of clinical delimitation of borders. We report here a case of a 69-year-old female patient presenting with brownish macules on her face, since 10 years ago, with histopathological diagnosis of lentigo maligna. The surgical management employed was excision of visible borders with the contoured technique and immediate submission of these borders for histopathological analysis before complete excision of the tumor. This technique is a variant of staged excision, with lower rates of recurrence and acceptable aesthetic results.

Utilidad de la dermatoscopia para el diagnóstico diferencial del lentigo maligno del resto de máculas pigmentadas en rostro / Dermoscopy utility for the differential diagnosis of lentigo maligna from the rest of facial pigmented macules

La diferenciación clínica de máculas pigmentadas en rostro puede ser dificultosa. No es raro el diagnóstico de malignidad en lesiones clínicamente triviales. Además, en esta localización la dermatoscopía presenta criterios específicos debido a la histología particular observada en zonas fotoexpuestas. Objetivos: Describir las características dermatoscópicas observadas en máculas pigmentadasen rostro de pacientes vistos en el Servicio de Dermatología del Hospital Privado de Córdoba. Determinar la sensibilidad y especificidad de la dermatoscopía para el diagnósticode máculas pigmentadas en rostro. Investigar la frecuencia de hallazgos sugestivos de lentigo maligno (LM) en otras máculas pigmentadas de la cara.Materiales y Métodos: Se diseñó un estudio de diagnóstico, observacional, transversal, prospectivo y descriptivo. Se incluyeron todos los pacientes mayores de 15 años con máculas pigmentadas en rostro que fueron atendidos en el servicio de Dermatología del Hospital Privado de Córdoba durante el período de un año. Resultados: Se incluyeron 53 pacientes y 56 máculas pigmentadas. Los criterios dermatoscópicos más frecuentes fueron los puntos/glóbulos grises, los puntos/glóbulos oscuros, las áreas homogéneas claras y las aperturas foliculares asimétricas. Los criterios mássensibles y específicos para el diagnóstico de LM fueron las áreas homogéneas oscuras, las líneas oscuras, las aperturas foliculares asimétricas y las estructuras romboidales.Conclusión: No se encontró un único criterio dermatoscópico que sea específico de lentigo maligno/lentigo maligno melanoma (LM/LMM). Se alcanzó una máxima sensibilidady especificidad al combinar 3 ó 4 criterios...

Desmoplastic melanoma associated with an intraepidermal lentiginous lesion: case report and literature review / Melanoma desmoplásico associado a lesão lentiginosa intraepidérmica, com evolução de 10 anos: relato de caso e revisão bibliográfica

Desmoplastic melanoma tends to present as firm, amelanotic papules. Microscopically, it reveals a proliferation of fusiform cells in the dermis and variable collagen deposition, as well as intraepidermal melanocytic proliferation of lentiginous type in most cases. Biopsy in a 61-year-old white male patient, who had received a diagnosis of lentigo maligna on his face 10 years before, revealed a proliferation of dermal pigmented spindle cells and collagen deposition, reaching the deep reticular dermis, with a lentiginous component. Immunohistochemistry with S-100, Melan-A and WT1 showed positivity, but it was weak with HMB45. Desmoplastic melanoma associated with lentigo maligna was diagnosed. Several authors discuss whether desmoplastic melanoma represents a progression from the lentiginous component or arises "de novo". Desmoplastic melanoma represents a minority of cases of primary cutaneous melanoma (less than 4%). Identification of lentigo maligna indicates that desmoplastic melanoma should be carefully investigated.

Os melanomas desmoplásicos apresentam-se como pápulas amelanóticas firmes; à microscopia exibem proliferação de células fusiformes na derme e variável deposição de colágeno, além de proliferação melanocítica lentiginosa, intraepidérmica, na maioria dos casos. Realizada biópsia de pele de paciente masculino, 61 anos, branco, com diagnóstico de lentigo maligno na face, há 10 anos. O exame histopatológico revela proliferação dérmica de células fusiformes pigmentadas e deposição de colágeno, invadindo até a profundidade da derme reticular, associado a componente lentiginoso; presença de positividade imuno-histoquímica com S-100, Melan-A e WT1, e marcação fraca com HMB45. Diagnóstico de melanoma desmoplásico, associado a lentigo maligno. Existe divergência quanto à origem do melanoma desmoplásico, a partir do componente lentiginoso ou "de novo", na ausência de lentigo associado. O melanoma desmoplásico representa uma minoria dos casos de melanoma cutâneo primário (menos de 4%). A presença de lentigo maligno pode servir de sinal de alerta para possível relação com melanoma desmoplásico.

Lentigo maligno tratado com imiquimode tópico: o valor da dermatoscopia no monitoramento clínico / Lentigo maligna treated with topical imiquimod: dermatoscopy usefulness in clinical monitoring

A dermatoscopia tem seu uso consagrado na avaliação diagnóstica de lesões melanocíticas. Recentemente, entretanto, tem se revelado também como importante ferramenta no acompanhamento da resposta terapêutica em diversas dermatoses. Relatamos o caso de uma paciente idosa, com diagnóstico de lentigo maligno de difícil manejo cirúrgico, para a qual optamos pelo uso do imiquimode tópico. O acompanhamento dermatoscópico dessa alternativa terapêutica se mostrou de grande utilidade.

Dermoscopy has its usefulness well established in the diagnostic evaluation of melanocytic lesions. Recently, however, it has also shown to be an important tool in monitoring therapeutic response to various dermatoses. We report the case of an elderly patient diagnosed with lentigo maligna of difficult surgical management, which we have chosen to treat with topical imiquimod. The dermoscopic monitoring of this alternative therapy has shown to be of great usefulness.

Léntigo maligno: clínica, histopatología y tratamiento: [revisión] / Lentigo maligna: clinical - histopathological features and treatment: [review]

El léntigo maligno es un melanoma in situ y representa la lesión precursora del léntigo maligno melanoma, la forma invasora de este tumor. El léntigo maligno tiene unas características especiales que lo diferencian de las otras variantes del melanoma in situ, tanto en su presentación clínica como en su apariencia histológica y en su comportamiento biológico. El conocimiento de cada uno de estos aspectos de la biología tumoral permite al médico tratante la elección de la mejor alternativa terapéutica en cada caso.