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
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
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
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
Lentigo maligna (LM) is an in situ melanoma which usually occurs in s un-dam aged skin on the head and neck of elderly patients. Depending on the anatomical site and its size treatment of LM can be problematic and usu...Lentigo maligna (LM) is an in situ melanoma which usually occurs in s un-dam aged skin on the head and neck of elderly patients. Depending on the anatomical site and its size treatment of LM can be problematic and usually includes surgic al excision or radiotherapy. Recent reports indicate that topical imiquimodmay b e an effective treatment. However, no data on the underlying immune response in the skin during treatment of LM with topical imiquimod are available so far. We report a 62- year-old caucasian woman with a histologically verified LM which was successfully treated with topical imiquimod 5% cream. Skin biopsy specime ns were obtained before, during (at week 10) and 4 weeks after cessation of topi cal treatment with imiquimod 5% cream. Histological and immunohistochemical ex amination was performed in order to detect residual atypical melanocytes and to characterize the inflammatory infiltrate. A complete clinical and histological c learance of the skin lesion was achieved, with no recurrence up to 9 months afte r the end of treatment. During topical application of imiquimod 5% cream a dep letion of epidermal and dermal CD1a+ dendritic cells was observed. The inflamm atory infiltrate consisted of CD68+ macrophages and mainly of CD3+ T cells w ith a slight predominance of CD8+ T cells. An enhanced expression of granzyme B and TIA- 1 was also noted particularly in the epidermis and near the dermoepi dermal junction. In conclusion, our data indicate that imiquimod 5% cream indu ces a cytotoxic T-cell-mediated immune response in situ which may account fo r the complete destruction of the malignant melanocytes in LM. Further clinical trials and longer follow-up periods on the use of imiquimod for LM are warrant ed.展开更多
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 biop...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.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
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Lentigo maligna (LM) is an in situ melanoma which usually occurs in s un-dam aged skin on the head and neck of elderly patients. Depending on the anatomical site and its size treatment of LM can be problematic and usually includes surgic al excision or radiotherapy. Recent reports indicate that topical imiquimodmay b e an effective treatment. However, no data on the underlying immune response in the skin during treatment of LM with topical imiquimod are available so far. We report a 62- year-old caucasian woman with a histologically verified LM which was successfully treated with topical imiquimod 5% cream. Skin biopsy specime ns were obtained before, during (at week 10) and 4 weeks after cessation of topi cal treatment with imiquimod 5% cream. Histological and immunohistochemical ex amination was performed in order to detect residual atypical melanocytes and to characterize the inflammatory infiltrate. A complete clinical and histological c learance of the skin lesion was achieved, with no recurrence up to 9 months afte r the end of treatment. During topical application of imiquimod 5% cream a dep letion of epidermal and dermal CD1a+ dendritic cells was observed. The inflamm atory infiltrate consisted of CD68+ macrophages and mainly of CD3+ T cells w ith a slight predominance of CD8+ T cells. An enhanced expression of granzyme B and TIA- 1 was also noted particularly in the epidermis and near the dermoepi dermal junction. In conclusion, our data indicate that imiquimod 5% cream indu ces a cytotoxic T-cell-mediated immune response in situ which may account fo r the complete destruction of the malignant melanocytes in LM. Further clinical trials and longer follow-up periods on the use of imiquimod for LM are warrant ed.
文摘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.
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.
