DermatopathologyContiguous lesions in lentigo maligna
Section snippets
Materials and methods
One hundred forty-seven lesions of LM were retrieved from the files of Brooke Army Medical Center and Geisinger Medical Center. All had histologic features diagnostic of LM (a predominantly junctional proliferation of atypical melanocytes on heavily sun-damaged skin, characterized by areas of confluent junctional growth, elongated, confluent, and irregular junctional nests, and extension along adnexal structures). Ninety-six of the specimens were consecutive debulking specimens taken before
Results
Seventy (48.0%) of the 147 cases of facial LM represented by Mohs debulking specimens and large shave biopsies on sun-damaged skin demonstrated a contiguous lesion (Table I). In 77 biopsies (52.0%), there was no evidence of a contiguous pigmented lesion, but 2 of these cases were remarkable for a lichenoid tissue reaction spanning a large portion of the specimen. Diagnostic features of LM were restricted to the remaining areas of the specimen.
Forty-four (30%) cases of LM studied demonstrated
Discussion
Pigmented lesions suspicious for LM are typically large and present in cosmetically sensitive areas. Complete excision and large incisional biopsies are impractical. Smaller biopsies, in the range of 4 mm to 6 mm are often submitted to the pathology lab.
In our study, 48% of the specimens of LM contained a contiguous pigmented lesion in at least a 6 mm segment. Fig 1, A demonstrates a portion of a LM debulking specimen. This portion is diagnostic of a benign solar lentigo. No diagnostic features
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[Translated article] Update on Lentigo Maligna: Diagnostic Signs and Treatment
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2019, Journal of the American Academy of DermatologyLentigo Maligna, Macules of the Face, and Lesions on Sun-Damaged Skin: Confocal Makes the Difference
2016, Dermatologic ClinicsCitation Excerpt :For example, it has been suggested that solar lentigo with melanocytic hyperplasia, so-called unstable solar lentigo, could also represent a precursor lesions to LM.67 The threshold at which a certain number of atypical melanocytes should be diagnosed as LM as opposed to solar damage is unknown,50,52 making diagnosis particularly difficult for pathologists because there are no clear guidelines to distinguish the stages of the disease.68 Stolz and colleagues24 created a 4-stage dermatoscopic model of tumor progression from LM to LMM, but the sensitivity and specificity of this model are yet to be tested on a large number of lesions or in correlation with RCM.
Skin biopsy: Biopsy issues in specific diseases
2016, Journal of the American Academy of DermatologyCitation Excerpt :Lentigo maligna deserves special mention; the large size of the lesion often precludes complete excision. Misdiagnosis is common in small specimens because of the lack of effacement of rete ridges, areas of regression, and collision with nonmelanocytic pigmented lesions, such as benign lentigines and pigmented actinic keratosis.58-60 Punch biopsy specimens are associated with a high rate of false-negative results.61-63
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Funding sources: None.
Conflicts of interest: None identified.
Presented in part at the American Academy of Dermatology Meeting, New York, July 2004.
The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the US Army or the Department of Defense.
Reprints not available from the authors.