DNA was extracted from 52 thick primary melanomas and mutations sought in exon 15 of the BRAF (v-raf murine sarcoma viral oncogene homolog B1) gene using denaturing high performance liquid chromatograph (dHPLC) fragme...DNA was extracted from 52 thick primary melanomas and mutations sought in exon 15 of the BRAF (v-raf murine sarcoma viral oncogene homolog B1) gene using denaturing high performance liquid chromatograph (dHPLC) fragment analysis, sequencing, and allele-specific PCR. Exon 15 BRAF mutations were found in 13 of 52 (25% ) primary melanomas. These comprised five of 17 (29% ) superficial spreading melanomas, three of 11 (27% ) nodular melanomas, two of 13 (15% ) acral lentiginous melanomas, one of one (100% ) mucosal melanoma and two of 10 (20% ) lentigo maligna melanomas. In common with other groups, our findings show a relative concentration of the exon 15 BRAF mutation in superficial spreading and nodular melanomas, but add further evidence that this mutation not necessary for malignant transformation of the melanocyte.展开更多
Lentigo maligna (LM) is a melanocytic lesion which is a potential precursor to melanoma and often has a prolonged intraepidermal growth phase before evolving into lentigo ma-ligna melanoma (LMM). LM is also noted for ...Lentigo maligna (LM) is a melanocytic lesion which is a potential precursor to melanoma and often has a prolonged intraepidermal growth phase before evolving into lentigo ma-ligna melanoma (LMM). LM is also noted for its tendency to locally recur after treatment. We present a patient who had a persistent LM on her left cheek which, despite multiple excisions, persisted and transformed into a partially amelanotic LMM roughly three decades later. Our patient’s course was also notable for this melanoma recurring at the edge of, and subsequently migrating into, a previously placed skin graft.展开更多
We report the case of a 70- year-old white male with an extensive recurrence of lentigo maligna in a skin-transplanted region. He was treated with imiquimod 5% cream topically applied 5 times a week for a total durati...We report the case of a 70- year-old white male with an extensive recurrence of lentigo maligna in a skin-transplanted region. He was treated with imiquimod 5% cream topically applied 5 times a week for a total duration of 9 months. Clinically and histologically, a complete clearing of the lesion was observed after treatment. Topical treatment with imiquimod seems to be effective and safe in lentigo maligna.展开更多
Background: Lentigo maligna (LM) is an in situ form of malignant melanoma, and surgical excision is often unsatisfactory. Imiquimod cream is an immune response modifier and induces a predominantly T-helper 1 type resp...Background: Lentigo maligna (LM) is an in situ form of malignant melanoma, and surgical excision is often unsatisfactory. Imiquimod cream is an immune response modifier and induces a predominantly T-helper 1 type response. Objectives: Assessment of histological and clinical response of surgically resectable LM after treatment with 5%imiquimod cream. Methods: Six patients with LM were treated with 5%imiquimod cream daily for 6 weeks. The whole site of the original lesion was then excised. Clinical and histological and appearances were measured using clinical response and histological grading scores. Results: Complete or almost complete clearance of pigmentation with minimal residual histological evidence of LM was observed in four patients, one patient showed no clinical or histological improvement, and the remaining patient had almost no residual pigmentation clinically after treatment yet histopathological changes remained as severe as before treatment. Conclusions: Topical imiquimod cream merits further investigation as a new therapy for LM.展开更多
Up until now, only lesions selected on the basis of their clinical atypia or which appear equivocal on naked eye examination have been shown to benefit from the use of dermoscopy. In our experience, dermoscopic evalua...Up until now, only lesions selected on the basis of their clinical atypia or which appear equivocal on naked eye examination have been shown to benefit from the use of dermoscopy. In our experience, dermoscopic evaluation of lesions located on the face may require a different approach, as a histopathological diagnosis of malignancy is not uncommon in clinically trivial lesions (i.e. lesions lacking the ABCD criteria for clinical suspicion). Moreover, at this site dermoscopy reveals specific criteria according to the particular histological architecture shown by sun- damaged skin. We report four cases of lentigo maligna (LM) of the face whose identification depended on dermoscopic examination which was performed routinely on all faciallesions,as the lesions did not show ABCD clinical criteria for malignancy. In our experience, the identification of early signs of malignancy by dermoscopy may indicate the excision of LM at an early phase, before the lesion is associated with the ABCD signs of melanoma. Dermatologists should avoid the mistake of immediately excluding a diagnosis of malignancy when examining an ABCD- negative pigmented skin lesion of the face.展开更多
Knowledge of the accurate margins of a lentigo maligna melanoma (LMM) is crucial in the presurgical evaluation of the patient. Towards this end clinicians have utilized the Wood’ s lamp and dermoscopy to help delinea...Knowledge of the accurate margins of a lentigo maligna melanoma (LMM) is crucial in the presurgical evaluation of the patient. Towards this end clinicians have utilized the Wood’ s lamp and dermoscopy to help delineate the borders of the LMM.However, many LMMs arise on photo damaged skin, making it difficult to determine the border of the LMM and separate it from the background lentiginous skin. We present a case of a patient with a recurrent LMM on the scalp that developed in a background of photodamage with diffuse melanocytic atypia and lentigines, making it virtually impossible to determine the precise margins of the LMM by clinical, Wood’ s lamp or dermoscopic examination. To avoid subjecting the patient to multiple staged excisions we attempted to determine the margins of the LMM by utilizing in vivo confocal laser scanning reflectance microscopy. Using this, it was apparent that there were increased numbers of atypical/dendritic intraepidermal melanocytes in all layers of the epidermis within the LMM. In contrast, skin not involved with the LMM, as viewed under confocal laser examination, had normal honeycomb architecture and no abnormal melanocytes. The confocally determined border was further confirmed by obtaining multiple punch biopsies that were evaluated by haematoxylin and eosin histology and immunohistochemistry. Based on this information, the presurgical margins were marked and the tumour excised accordingly. The excised tissue was examined with multiple- step sections and the margins were determined to be clear. There has been no evidence of tumour recurrence after 1 year. In conclusion, this case illustrates that confocal reflect ancemicroscopy, in conjunction with other in vivo optical instruments, can be utilized to enhance the accuracy for the presurgical margin mapping of LMM.展开更多
Objective: To compare identification of the border of lentigo maligna (LM) with digital epiluminescence microscopy (DELM) with clinical and Wood light assessment. Design: The borders of lesions identified clinically w...Objective: To compare identification of the border of lentigo maligna (LM) with digital epiluminescence microscopy (DELM) with clinical and Wood light assessment. Design: The borders of lesions identified clinically with the Wood light, with DELM, and after excision by Mohs micrographic surgery were traced onto plastic sheets. The borders defined on the tracings were compared for congruence and mean surface area. Setting: Cardinal Bernardin Cancer Center for Skin Cancer, Loyola University Health System, Maywood, Ill. Patients: Twenty-six consecutive patients with LM of the head and neck. Main Outcome Measures: Results of the comparison of the outlines of the borders and the mean surface area identified by the 4 methods. Results: The border determined by clinical examinationwas smaller than that determinedwith the Wood lamp or by DELM. Most lesions underwent an additional excision 5 mm beyond the DELM-defined border. The DELM pattern of LM with asymmetric follicular openings and dark brown rhomboidal structures changed at the periphery and became a pigmented thin mesh that was associated with the histopathological features of melanoma in situ. More homogeneous pigmented areas extending from the LM were associated with the pathologic features of melanocytic hyperplasia. Conclusions: Visualization of LM by DELM (dermoscopy) helps to guide resection. Because LM arises in sun-damaged skin with melanocytic hyperplasia, determining the tumor-free margin requires the judgment of an experienced physician.展开更多
Follicular malignant melanoma can be regarded as a rare and unique presentation ofmelanoma. It is characterized by a deepseated follicular structure in which atypicalmelanocytes extend downward along the follicular ep...Follicular malignant melanoma can be regarded as a rare and unique presentation ofmelanoma. It is characterized by a deepseated follicular structure in which atypicalmelanocytes extend downward along the follicular epitheliumand permeate parts of the follicle as well as the adjacent dermis. The clinical diagnosis of follicular malignant melanoma may be difficult because the tumor mostly resembles a comedo or a pigmented cyst. We studied five cases of follicular malignant melanoma in which the patients were between 61 and 82 years old. Three lesions were localized on the nose, one on the cheek, and one on the back of the neck. Clinically, all five cases measured distinctly less than 0.5 cm in size. While lentigo maligna is traditionally known as a pigmented macule in actinically damaged skin that gradually evolves in a slow process before invasive growth, three follicular malignant melanomas had developed in relatively short timeframes of 9 months to 1 1/2 years. In all five cases the inconspicuous clinical appearance did not herald a malignant melanoma with invasive growth. Follicular malignant melanoma underlines the importance of a correct excision technique with subsequent histologic workup and diagnosis. Superficial shave excision or even laser treatment in these specific cases may lead to a fatal prognosis for the patient.展开更多
We report a 64-year-old man with a pigmented lesion on his forehead, initially thought to be actinic lentigo. At follow-up 1 year later the lesion had increased in size and showed new areas of pigmentation. Dermoscopi...We report a 64-year-old man with a pigmented lesion on his forehead, initially thought to be actinic lentigo. At follow-up 1 year later the lesion had increased in size and showed new areas of pigmentation. Dermoscopic observation and biopsy led to a diagnosis of lentigo maligna and the lesion was excised. The dermoscopic features indicative of early growth of lentigo maligna are identified and discussed.展开更多
文摘DNA was extracted from 52 thick primary melanomas and mutations sought in exon 15 of the BRAF (v-raf murine sarcoma viral oncogene homolog B1) gene using denaturing high performance liquid chromatograph (dHPLC) fragment analysis, sequencing, and allele-specific PCR. Exon 15 BRAF mutations were found in 13 of 52 (25% ) primary melanomas. These comprised five of 17 (29% ) superficial spreading melanomas, three of 11 (27% ) nodular melanomas, two of 13 (15% ) acral lentiginous melanomas, one of one (100% ) mucosal melanoma and two of 10 (20% ) lentigo maligna melanomas. In common with other groups, our findings show a relative concentration of the exon 15 BRAF mutation in superficial spreading and nodular melanomas, but add further evidence that this mutation not necessary for malignant transformation of the melanocyte.
文摘Lentigo maligna (LM) is a melanocytic lesion which is a potential precursor to melanoma and often has a prolonged intraepidermal growth phase before evolving into lentigo ma-ligna melanoma (LMM). LM is also noted for its tendency to locally recur after treatment. We present a patient who had a persistent LM on her left cheek which, despite multiple excisions, persisted and transformed into a partially amelanotic LMM roughly three decades later. Our patient’s course was also notable for this melanoma recurring at the edge of, and subsequently migrating into, a previously placed skin graft.
文摘We report the case of a 70- year-old white male with an extensive recurrence of lentigo maligna in a skin-transplanted region. He was treated with imiquimod 5% cream topically applied 5 times a week for a total duration of 9 months. Clinically and histologically, a complete clearing of the lesion was observed after treatment. Topical treatment with imiquimod seems to be effective and safe in lentigo maligna.
文摘Background: Lentigo maligna (LM) is an in situ form of malignant melanoma, and surgical excision is often unsatisfactory. Imiquimod cream is an immune response modifier and induces a predominantly T-helper 1 type response. Objectives: Assessment of histological and clinical response of surgically resectable LM after treatment with 5%imiquimod cream. Methods: Six patients with LM were treated with 5%imiquimod cream daily for 6 weeks. The whole site of the original lesion was then excised. Clinical and histological and appearances were measured using clinical response and histological grading scores. Results: Complete or almost complete clearance of pigmentation with minimal residual histological evidence of LM was observed in four patients, one patient showed no clinical or histological improvement, and the remaining patient had almost no residual pigmentation clinically after treatment yet histopathological changes remained as severe as before treatment. Conclusions: Topical imiquimod cream merits further investigation as a new therapy for LM.
文摘Up until now, only lesions selected on the basis of their clinical atypia or which appear equivocal on naked eye examination have been shown to benefit from the use of dermoscopy. In our experience, dermoscopic evaluation of lesions located on the face may require a different approach, as a histopathological diagnosis of malignancy is not uncommon in clinically trivial lesions (i.e. lesions lacking the ABCD criteria for clinical suspicion). Moreover, at this site dermoscopy reveals specific criteria according to the particular histological architecture shown by sun- damaged skin. We report four cases of lentigo maligna (LM) of the face whose identification depended on dermoscopic examination which was performed routinely on all faciallesions,as the lesions did not show ABCD clinical criteria for malignancy. In our experience, the identification of early signs of malignancy by dermoscopy may indicate the excision of LM at an early phase, before the lesion is associated with the ABCD signs of melanoma. Dermatologists should avoid the mistake of immediately excluding a diagnosis of malignancy when examining an ABCD- negative pigmented skin lesion of the face.
文摘Knowledge of the accurate margins of a lentigo maligna melanoma (LMM) is crucial in the presurgical evaluation of the patient. Towards this end clinicians have utilized the Wood’ s lamp and dermoscopy to help delineate the borders of the LMM.However, many LMMs arise on photo damaged skin, making it difficult to determine the border of the LMM and separate it from the background lentiginous skin. We present a case of a patient with a recurrent LMM on the scalp that developed in a background of photodamage with diffuse melanocytic atypia and lentigines, making it virtually impossible to determine the precise margins of the LMM by clinical, Wood’ s lamp or dermoscopic examination. To avoid subjecting the patient to multiple staged excisions we attempted to determine the margins of the LMM by utilizing in vivo confocal laser scanning reflectance microscopy. Using this, it was apparent that there were increased numbers of atypical/dendritic intraepidermal melanocytes in all layers of the epidermis within the LMM. In contrast, skin not involved with the LMM, as viewed under confocal laser examination, had normal honeycomb architecture and no abnormal melanocytes. The confocally determined border was further confirmed by obtaining multiple punch biopsies that were evaluated by haematoxylin and eosin histology and immunohistochemistry. Based on this information, the presurgical margins were marked and the tumour excised accordingly. The excised tissue was examined with multiple- step sections and the margins were determined to be clear. There has been no evidence of tumour recurrence after 1 year. In conclusion, this case illustrates that confocal reflect ancemicroscopy, in conjunction with other in vivo optical instruments, can be utilized to enhance the accuracy for the presurgical margin mapping of LMM.
文摘Objective: To compare identification of the border of lentigo maligna (LM) with digital epiluminescence microscopy (DELM) with clinical and Wood light assessment. Design: The borders of lesions identified clinically with the Wood light, with DELM, and after excision by Mohs micrographic surgery were traced onto plastic sheets. The borders defined on the tracings were compared for congruence and mean surface area. Setting: Cardinal Bernardin Cancer Center for Skin Cancer, Loyola University Health System, Maywood, Ill. Patients: Twenty-six consecutive patients with LM of the head and neck. Main Outcome Measures: Results of the comparison of the outlines of the borders and the mean surface area identified by the 4 methods. Results: The border determined by clinical examinationwas smaller than that determinedwith the Wood lamp or by DELM. Most lesions underwent an additional excision 5 mm beyond the DELM-defined border. The DELM pattern of LM with asymmetric follicular openings and dark brown rhomboidal structures changed at the periphery and became a pigmented thin mesh that was associated with the histopathological features of melanoma in situ. More homogeneous pigmented areas extending from the LM were associated with the pathologic features of melanocytic hyperplasia. Conclusions: Visualization of LM by DELM (dermoscopy) helps to guide resection. Because LM arises in sun-damaged skin with melanocytic hyperplasia, determining the tumor-free margin requires the judgment of an experienced physician.
文摘Follicular malignant melanoma can be regarded as a rare and unique presentation ofmelanoma. It is characterized by a deepseated follicular structure in which atypicalmelanocytes extend downward along the follicular epitheliumand permeate parts of the follicle as well as the adjacent dermis. The clinical diagnosis of follicular malignant melanoma may be difficult because the tumor mostly resembles a comedo or a pigmented cyst. We studied five cases of follicular malignant melanoma in which the patients were between 61 and 82 years old. Three lesions were localized on the nose, one on the cheek, and one on the back of the neck. Clinically, all five cases measured distinctly less than 0.5 cm in size. While lentigo maligna is traditionally known as a pigmented macule in actinically damaged skin that gradually evolves in a slow process before invasive growth, three follicular malignant melanomas had developed in relatively short timeframes of 9 months to 1 1/2 years. In all five cases the inconspicuous clinical appearance did not herald a malignant melanoma with invasive growth. Follicular malignant melanoma underlines the importance of a correct excision technique with subsequent histologic workup and diagnosis. Superficial shave excision or even laser treatment in these specific cases may lead to a fatal prognosis for the patient.
文摘We report a 64-year-old man with a pigmented lesion on his forehead, initially thought to be actinic lentigo. At follow-up 1 year later the lesion had increased in size and showed new areas of pigmentation. Dermoscopic observation and biopsy led to a diagnosis of lentigo maligna and the lesion was excised. The dermoscopic features indicative of early growth of lentigo maligna are identified and discussed.
