Lentigo maligna melanoma in situ with neurotropism.

Perineural invasion, or neurotropism, is defined by the presence of cancer cells either within the neuronal sheath or found along the nerves. In melanoma, it is most commonly associated with invasive desmoplastic melanoma, a melanoma that is most commonly associated with malignant melanoma in situ, lentigo maligna type. Initially, perineural invasion was included in the reported Breslow thickness; however, recent data suggest that it should not be included. In this report, we describe a case of malignant melanoma in situ, lentigo maligna type, with associated neurotropism in the absence of invasive component.

Descripción de los pacientes intervenidos mediante cirugía de Mohs en España. Datos basales del registro español de cirugía de Mohs (REGESMOHS) / Description of Patients Undergoing Mohs Surgery in Spain: Initial Report on Data From the Spanish Registry of Mohs Surgery (REGESMOHS)

INTRODUCCIÓN: En julio de 2013 se inició la recogida de datos del registro español de cirugía micrográfica de Mohs, que describe la aplicación y los resultados de esta técnica en España. En este artículo se describen las características del paciente y de los tumores tratados. MATERIAL Y MÉTODOS: Se trata de un estudio de cohortes prospectivo en el que participan centros en los que se practica al menos una intervención semanal de cirugía micrográfica de Mohs. En cada centro se incluyen todos los pacientes que son valorados para realizar cirugía de Mohs, excepto los declarados judicialmente incapaces. En este artículo describimos las características de los pacientes y los tumores incluidos en la cohorte. RESULTADOS: El número de pacientes incluidos desde julio de 2013 hasta octubre de 2014 es de 655. La mayoría de los tumores cutáneos intervenidos correspondieron a carcinoma basocelular, siendo el infiltrante el subtipo histológico más frecuente. La mayoría de las cirugías se practicaron en tumores localizados en la cara y el cuero cabelludo, siendo la localización más frecuente la nariz. Casi el 40% de los tumores operados son recurrentes o persistentes, y el tamaño tumoral prequirúrgico es similar en nuestro medio al descrito en otros estudios australianos o europeos. Hasta el 45,5% de los pacientes había recibido algún tratamiento quirúrgico previo. CONCLUSIÓN: Los datos observados son similares a los de otras series publicadas, y son relevantes para poder valorar la aplicabilidad en nuestro contexto de estudios realizados en otros medios

INTRODUCTION: The Spanish registry of Mohs micrographic surgery started collecting data in July 2013. The aim of the registry is to report on the use of this technique in Spain and the outcomes achieved. In the present article, we describe the characteristics of patients and the tumors treated. MATERIAL AND METHODS: This is a prospective cohort study of patients treated with Mohs micrographic surgery. The participating centers are hospitals where at least one intervention of this type is performed each week. All patients considered for Mohs micrographic surgery in participating centers are included in the registry except those who have been declared legally incompetent. RESULTS: Between July 2013 and October 2014, data from 655 patients were included in the registry. The most common tumor involved was basal cell carcinoma, and the most common histological subtype was infiltrative basal cell carcinoma. Most of the tumors treated were located on the face or scalp, and the most common site was the nose. Almost 40% of the tumors treated were recurrent or persistent, and preoperative tumor size was similar to that reported in other European studies and in Australia. In total, 45.5% of patients had received previous surgical treatment. CONCLUSION: The findings are similar to those reported in other studies, and the data collected are useful for assessing whether the results of studies carried out elsewhere are applicable in Spain

Pseudomelanosis gástrica y duodenal: a propósito de dos casos / Gastric and duodenal pseudomelanosis: a propos of two cases

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A false-positive FDG uptake in Teflon granuloma: a case report.

Positron emmision tomography (PET) is successfully used to monitor malignancies. Unfortunately it is not tumor specific. We present a case with history of rectum cancer and lentigo maligna who underwent PET-CT which revealed an increased uptake in the larynx. What was first considered as a third primary turned out to be a Teflon granuloma.

Recurrent lentigo maligna melanoma commingling the tumour nests of a basal cell carcinoma.

There are various types and combinations of coexisting cutaneous neoplasms which have been documented in the past but are uncommon. In this report we describe a case of basal cell carcinoma (BCC) colonised by recurrent lentigo maligna melanoma. A review of the literature has established the coexistence of lentigo maligna and BCC in six cases. The unusual combination of melanoma and BCC poses a therapeutic and prognostic dilemma. BCC is known to have a favourable outcome whereas melanoma tends to behave in a more aggressive manner leading to a less favourable outcome. There are conflicting views as to whether these lesions should be treated as BCC's or lentigo maligna melanoma. Our case appears to be unique, in that it was a recurrent lentigo maligna melanoma which was colonising the BCC. We treated our patient with wide local excision and full thickness skin graft and will continue to observe him on an outpatient basis. There needs to be long term follow up of a larger number of patients for us to truly appreciate the biological significance of parasitism of BCC by lentigo maligna melanoma.

Tratamiento quirúrgico del lentigo maligno: cirugía convencional vs. Mohs diferida. Estudio retrospectivo de 62 casos / Conventional Surgery Compared With Slow Mohs Micrographic Surgery in the Treatment of Lentigo Maligna: A Retrospective Study of 62 Cases

Introducción: El tratamiento estándar del lentigo maligno (LM) es la escisión quirúrgica con márgenes de 0,5 cm. Sin embargo, dada la mala delimitación de muchos tumores, es frecuente que esta exéresis sea incompleta. Objetivo: identificar parámetros clínicos que puedan predecir qué LM localizados en la cabeza, extirpados de forma primaria o tras recidivar, se extienden más allá de los límites visibles y por tanto, puedan requerir márgenes quirúrgicos más amplios. Material y métodos: se revisó retrospectivamente la información clínica de los pacientes con LM localizado en la cabeza cuyo tratamiento quirúrgico definitivo, mediante cirugía convencional o cirugía de Mohs diferida, fue realizado en el Servicio de Dermatología del Instituto Valenciano de Oncología (IVO) entre enero de 1993 y abril de 2011. Resultados: un 69,2% de los LM recidivados y un 26,5% de los tumores primarios requirieron márgenes de más de 0,5 cm. La administración previa de tratamientos que puedan interferir en la delimitación clínica, la localización centro facial y las lesiones que se presentan en pacientes con fototipos altos (III-V) fueron los factores asociados a la necesidad de márgenes quirúrgicos más amplios. Conclusiones: la utilización de márgenes de 0,5 cm para el tratamiento del LM es insuficiente para un número importante de casos localizados en la cabeza, especialmente los recidivados. La cirugía de Mohs diferida, con el estudio de todos los márgenes en parafina, parece el tratamiento de elección en particular para los casos recidivados o en los que la delimitación clínica pueda verse dificultada (AU)

Introduction: Surgical excision with margins of 0.5 cm is the standard treatment for lentigo maligna (LM). Excision, however, is often incomplete as many of these tumors have indistinct borders. Objective: To identify clinical predictors of subclinical extension in primary and recurrent LM of the head and thereby determine which lesions might require wider surgical margins. Material and methods: We reviewed the clinical records of patients with LM of the head treated definitively with conventional surgical excision or slow micrographic Mohs surgery (MMS) at the dermatology department of Instituto Valenciano de Oncología between January 1993 and April2011. Results: Surgical margins larger than 0.5 cm were required in 69.2% of recurrent LM and 26.5% of primary LM. Factors associated with the need for wider margins were prior treatment that might have interfered with the clinical delineation of the border, lesions in the center of the face, and skin phototypes III to V. Conclusions: Surgical margins of 0.5 cm are inadequate for the treatment of a considerable number of LM lesions located on the head, particularly if these are recurrent. Slow MMS using paraffin-embedded sections appears to be the treatment of choice in such cases, particularly for recurrent lesions or lesions with poorly defined borders or possible subclinical extension (AU)

Xeroderma pigmentosum and lentigo maligna in identical twins.

Xeroderma pigmentosum (XP) is a rare autosomal recessive genodermatosis. Skin abnormalities result from an inability to repair UV-damaged DNA. Clinically, XP presents with early onset cutaneous changes (severe photosensitivity, actinic keratoses, and telangiectasias) and an increase of developing cutaneous malignancies beginning in early childhood, but lentigo maligna and melanomas are relatively rare. Here we report on homozygote twins in whom there was no positive family history. They showed subnormal physical growth. On ophthalmological examination, both had photophobia and decreased visual acuity. Since birth, several excisions had been performed for skin neoplasms. In one of them a pigmented patch developed over the frontal area which proved to be lentigo maligna and she was referred to a dermato-oncology center. They have been given isotretinoin and physical sunscreen since then. The follow-up period was extended to 2 years and no serious complications occurred from the above treatment. This is an interesting report about XP in twins with the presentation of the rare neoplasm lentigo maligna.

Contiguous lesions in lentigo maligna.

BACKGROUND: Determining the best biopsy technique for a suspected lentigo maligna can be challenging. Because complete excisional biopsy is rarely practical, the physician is left to choose an appropriate area to biopsy. Sampling error can have devastating consequences, especially if the biopsy demonstrates a pigmented lesion that was considered in the clinical differential diagnosis. The presence of a solar lentigo, pigmented actinic keratosis, or reticulated seborrheic keratosis could mislead the pathologist and clinician to the erroneous conclusion that the incisional specimen is representative of the whole, and that no lentigo maligna is present. OBJECTIVE: We have often observed the presence of a contiguous pigmented lesion adjacent to lentigo maligna. The current study was designed to determine how frequently this phenomenon occurs. METHODS: We studied Mohs debulking specimens of lentigo maligna, and broad shave biopsy specimens of pigmented lesions on heavily sun-damaged areas of the skin proven to be lentigo maligna. RESULTS: Contiguous pigmented lesions were present in 48% of the specimens. The most common lesion was a benign solar lentigo (30%), followed by pigmented actinic keratosis (24%). CONCLUSION: Recognition of this phenomenon may prevent misdiagnosis of lentigo maligna related to sampling error.

[Trigeminal neuralgia presenting as a deep recurrent desmoplastic neurotropic melanoma of a lentigo maligna]. / Névralgie faciale révélatrice d'une récidive desmoplastique profonde et neurotrope d'un mélanome de Dubreuilh.

INTRODUCTION: Neurotropic melanoma is a particular anatomopathological form corresponding to dermal proliferation of desmoplastic cells of neuroid differentiation. We report a new case of neurotropic melanoma revealed by facial neuralgia. CASE REPORT: A 64 year-old man presented in 1996 with a lentigo maligna on the right cheek treated by complete excision. After 2 years of medical supervision, a pigmented lesion recurred leading to new surgical treatment. The histological examination of the total lesion showed intra-epidermal atypical melanocyte proliferation without dermal invasion. In 1999, right trigeminal neuralgia occurred without associated cutaneous change. Cranial MRI revealed an infiltration of the right trigeminal nerve. Endo-buccal surgery disclosed a black swelling of the trigeminal nerve. Histological examination and immunohistochemistry revealed a desmoplastic melanoma. DISCUSSION: Neurotropic melanoma with nerve invasion by malignant cells presenting as a trigeminal neuralgia is rare. Our case report underlined the depth of the neurotropic melanoma and the initial existence of a lentigo maligna without associated "neurotropic" melanoma.

[Malignant lentigo]. / Lentigo maligna.

Lentigo maligna (LM) is a premalignant skin alteration, which may progress to lentigo maligna melanoma (LMM). LM usually appears as a small dark brown spot in the head and neck region. Over some years it may gradually enlarge to palm size and the colour become more motley. Histologically many atypical melanocytes are seen in the basal layer of the epidermis and along the adnexal structures, as well as there being dermal elastosis and a lymphohistiocytic inflammatory infiltrate in the superficial dermis. Excision should be performed as soon as the diagnosis is made to avoid more extensive excision, transplantation and development into LMM later on. If transformation of LM into LMM occurs, often after many years, fast growth, increased pigmentation and sometimes a nodular formation are observed. Histologically, the atypical melanocytes have invaded the dermis.