Cirugía micrográfica de Mohs y técnica del espagueti para melanoma in situ de cabeza y cuello / Melanoma in situ of the head and neck treated with Mohs surgeryor “spaghetti technique”

Antecedentes: el lentigo maligno (LM) es un subtipo de melanoma in situ (MMis) que ocurre en áreas fotoexpuestas de cabeza y cuello (CC) de pacientes añosos. El margen quirúrgico necesario para su resección no fue confirmado por estudios controlados-randomizados.Existen distintas técnicas para el estudio histológico exhaustivo de márgenes: cirugía de Mohs (CMM), slow Mohs (SM), staged excision (SE) y técnica del espagueti (TE). Objetivo: describir las características epidemiológicas, clínicas, tratamiento y evolución de pacientes con MMis-CC tratados por nuestro grupo con CMM y TE. Diseño: estudio descriptivo, observacional y retrospectivo. Métodos: se analizó edad, sexo, histología, tratamiento y evolución de 103 MMis-CC en 102 pacientes, tratados entre 6/1996 y 6/2014. Resultados: edad promedio: 66 años. Mujeres: 54,4%. Anatomía patológica: LM: 63 y MMis: 40. Tratamiento previo: 25,2%. En 36 casos se empleó CMM (los primeros 20 en tejidos frescos y desde diciembre de 2009 en parafina (SM)). Desde mayo de 2011 (67 casos) se empleó TE. En el 86,4% fue necesaria 1 capa de Mohs, en 10 pacientes: 2 capas, en 3: 3 y en 1: 4. Se conoce la evolución de 101/102 pacientes, media de seguimiento:27,7 meses. A un paciente con lesión muy extensa que no completó la cirugía se lo excluyó del análisis de recidivas. Observamos 1 (0,99%) recidiva. Tasa de control de la enfermedad:99%. Conclusiones: las técnicas con control exhaustivo de márgenes para el tratamiento del MMis-CC son altamente eficaces, permiten preservar tejido sano en zonas de gran importanciafuncional y estética.

Background: lentigomaligna (LM) is a subtype of in situ melanoma (isMM)deberia serMIS. It usually occurs in sun-exposed areas of the head and neck (HN) of elderly patients.Safe surgical margins after removal were not confirmed by randomized and controlledstudies. There are different techniques for histological study of margins: Mohs surgery(MS), slow Mohs (SM), "staged excision" (SE) and spaghetti technique (ST).Objective: to describe epidemiological, clinical, treatment and outcome of patients withisMM-HN treated by our group using MS and ST.Design: descriptive, observational and retrospective study.Methods: we analyzed age, sex, histology, treatment and outcome of 103 isMM-HN in102 patients treated between 6/96 and 6/14.Results: mean age: 66 years. Women: 54.4%. Pathology: LM: 63 and isMM: 40. Previoustreatment:25.2%. MS in 36 cases (the first 20 with fresh tissue technique, and since12/09 with paraffin sections (SM)). Since 5/11 (67 cases) ST was preferred. In 86.4%, 1layer was necessary, 2 layers: 10, 3 layers: 3 and 4 layers: 1 patients. Known evolution:99% (102/103) with a median follow up of 27.7 months. A patient with an extensivelesion did not complete the surgery, and was excluded from the recurrence analysis. Weobserved 1 (0.99%) recurrence. Control of disease rate: 99%.Conclusions: the detailed margin-control techniques for the treatment of LM are highlyeffective, enabling to preserve healthy tissue at high functional and aesthetic importanceareas.

A Case of Melanoma in situ in a Child Presented with Melanonychia / 대한피부과학회지

Melanonychia is a darkening of the nails and its importance is that it may indicate the presence of a subungual malignant melanoma. Because the incidence of malignant melanoma is quite small in children, clinicians have had difficulties as to whether or not to perform a nail matrix biopsy in the children with melanonychia. Herein, we report the case of a 6-year-old boy that presented with melanonychia, which was determined to be confirmed melanoma in situ.

Non-amputative Surgical Management of Subungal Melanoma in Situ / 대한피부과학회지

Subungual melanoma is a variant of acral lentiginous melanoma and is thought to carry a poor prognosis due to difficulties in early diagnosis. Classical management of subungual melanoma is based on the radical surgery of distal phalanx amputation. Instead, conservative treatment with non-amputative wide excision of the nail unit followed by reconstruction has been insufficiently reported, especially in Korea. A 71-year-old woman presented with dark brownish longitudinal bands on her right thumbnail. Punch biopsies from the nail matrix and nail bed showed proliferation of atypical melanocytes without dermal involvement. We describe a case of subungual melanoma in situ of the right thumb, and a non-amputative surgical management which aims to provide adequate clearance of the lesion with minimal morbidity and satisfactory preservation of function for the patient.

Melanoma "in situ" tratado con Imiquimod / Melanoma in situ treated with Imiquimod

Comunicamos un caso con dos melanomas "in situ", en un varón de 86 años, localizados en ambos lados de la cara con alto riesgo quirúrgico, quien fuera tratado con imiquimod al 5% una vez al día durante dos meses; los resultados hasta el momento, clínicos e histológicos han sido satisfactorios.

A 86 years-old man with two melanomas "in situ" at both sides of his face, treated with imiquimod 5% are presented. The patient has a cardiovascular high risk due to isquemic heart disease, for that reason we start the treatment with imiquimod once a day for two months. The clinical and histological response was good and a follow up will be as long as we can.

Atypical Junctional Melanocytic Hyperplasia with Intradermal Nevus / 대한피부과학회지

Atypical junctional melanocytic hyperplasia is a rare condition with unknown etiology. It is characterized by focal atypical melanocytic proliferation limited in the basal layer. Although this lesion is difficult to separate from melanoma in situ (MIS), it could be distinguished from MIS by the lack of several features, including lateral spread, upward epidermal migration, marked cytologic atypia, finely granular "smoky" melanin pigment, mitotic figures, and a subjacent host inflammatory response. In one study, atypical junctional melanocytic hyperplasia was found in 6.2% (25/400) of otherwise normal intradermal nevi. However, to our knowledge, no case of atypical junctional melanocytic hyperplasia with intradermal nevus has ever been published in Korean dermatologic literatures. Herein, we report a rare and interesting case of atypical junctional melanocytic hyperplasia with intradermal nevus.

Acral Lentiginous Melanoma in situ / 대한피부과학회지

Acral lentiginous melanoma (ALM) is the most common subtype of melanoma in Asian countries including Korea. ALM was considered more aggressive than other subtypes, but recent reports suggest that it was because of late detection or delayed diagnosis, rather than a true biological difference. Therefore, early diagnosis of ALM is important for a better prognosis but its diagnosis is not always easy. There are scarce reports upon ALM in situ, probably due to its rarity and diagnostic difficulty, which makes in depth understanding and proper management of ALM in situ complicated. Therefore, we have reviewed our experience for twenty years with acral pigmented lesions showing intraepidermal proliferation of melanocytes which was diagnosed or suspected as ALM in situ.

Progression from Acral Lentiginous Melanoma in situ to Invasive Acral Lentiginous Melanoma

Acral lentiginous melanoma (ALM) is the most common type of cutaneous melanoma in Asians. The very early stage of ALM demonstrates only a proliferation of a few atypical melanocytes within the epidermis, and has been termed ALM in situ. A 74-year-old male patient presented with a pigmented lesion on the left great toe for 12 years, which had initially showed only a few scattered hyperplastic atypical melanocytes without dermal invasion upon biopsy 5 years ago. This time however, rebiopsy of the lesion confirmed a diagnosis of ALM, stage IIIB. It could be inferred that the lesion had slowly progressed from ALM in situ to invasive ALM over a period of 12 years. Herein we report a case of ALM in situ which progressed to invasive ALM over a long period of time. We expect this report may assist physicians in early recognition and proper management of future cases of ALM in situ.

A Case of Melanoma in situ Arising in a Small Congenital Melanocytic Nevus / 대한피부과학회지

It is uncertain whether small congenital melanocytic nevi is associated with an increased risk of melanoma. However, if a small congenital melanocytic nevus develops suspicious changes, becomes symptomatic, or is irregular, then an excisional biopsy may be justified. We report an interesting case of a 33-year-old man who was diagnosed with melanoma in situ, arising in a small congenital melanocytic nevus with a cyst. Histologic examination revealed that intradermal nests of nevus cells had surrounded the epidermal cyst. In the basal cell layer, and in the wall of the epidermal cyst, atypical melanocytes were observed.

Two Cases of Acral Lentiginous Melanoma in situ Presenting a Melanonychia / 대한피부과학회지

Black or brown pigmentation of the nail plate commonly results from melanin produced by melanocytes in the matrix secondary to inflammatory dermatoses or systemic medications. It can also be caused by a benign pigmented nevus in the matrix or malignant melanoma. We report two cases showing black discoloration of the finger nail which were histologically found to be acral lentiginous melanoma in situ. It follows that melanoma, when the cells are separated from the dermis by a basement membrane zone, will have a good prognosis. Total resection for the lesion, including the nail matrix and nail bed with a free margin of 0.5 to 1.0cm, may be adequate.

A Operated Case of Primary Melanoma of the Esophagus / 대한소화기내시경학회지

Malignant melanoma is a malignant neoplasm originated from melanocyte. Primary malignant melanoma of the esophagus is a very rare disease comprising 0.1% of all primary neoplasms of the esophagus. As with other primary mucosal malignant melanoma, primary malignant melanoma of the esophagus has poor prognosis because of the tendency to present as an advanced neoplasm with aggressive biological behavior. We present an operated case of primary malignant melanoma of the esophagus confirmed by the adjacent squamous mucosa contained junctional nests of tumor cells showing focal pagetoid spread consistent with melanoma in situ, with a clinicopoathological review of the literatures.