Annular pigmented actinic keratosis mimicking lentigo maligna melanoma in a 75-year-old female: An unusual presentation

Pigmented actinic keratosis (PAK) is an uncommon variant of actinic keratosis that can mimic different pigmented lesions, which may be benign or malignant. The diagnosis of PAK is often challenging because of overlapping features with lentigo maligna melanoma (LMM). Clinically, lesions of both conditions almost look similar; the diagnoses must be established histologically and with the help of immunostaining whenever needed. The distinction between a large PAK and LMM is important because their prognosis and management differ. We present a 75-year-old female with annular brown-to-black-colored maculo-plaque on forehead having clinical suspicious of melanocytic malignancy; which was diagnosed with a PAK on biopsy with help of histopathology and confirmed with Melan A/MART‑1 immunostaining.

Caracterización de pacientes con cáncer de piel y otras afecciones causadas por fotodaño / Characterization of patients with skin cancer and other affections caused by photodamage

Introducción: El fotodaño es la agresión producida por la radiación solar en la piel. A su vez, la radiación ultravioleta es uno de los primeros agentes considerados como generadores de cáncer. Objetivo: Caracterizar a los pacientes con neoplasias cutáneas y otras afecciones causadas por fotodaño, según variables clínicas seleccionadas. Métodos: Se realizó un estudio transversal, observacional, clínico, descriptivo y retrospectivo de 64 pacientes diagnosticados con alguna afección causada por fotodaño, pertenecientes al área de salud del consultorio médico No. 11 del Policlínico Aquiles Espinosa Salgado de Las Tunas, desde enero del 2020 hasta igual periodo del 2022. Se analizaron variables, tales como edad, sexo, color de la piel, fototipo de piel, ocupación, uso regular de medios de protección solar antes de los 18 años de edad y actualmente, así como enfermedad dermatológica causada por fotodaño. Resultados: Predominaron el grupo etario de 60 años y más (43,7%), el sexo femenino (54,7 %), el color de la piel blanco (98,5 %), el fototipo de piel III (59,4 %) y los trabajadores estatales (53,1%).Se halló, que 90,6 % de los pacientes no tenían antecedentes de exposición a radiaciones no ultravioletas; 25,0 % refirió usar regularmente algún medio de protección antes de los 18 años de edad y 51,5 % lo emplean actualmente. La enfermedad dermatológica causada por fotodaño que primó fue el cáncer de piel (37,5 %). Conclusiones: Este estudio denotó la pertinencia y necesidad de identificación de las características clínicas de los pacientes con afecciones causadas por fotodaño en el consultorio médico referido.

Introduction: Photodamage is the aggression caused by solar radiation in the skin. In turn, the ultraviolet radiation is one of the first agents considered as cancer generators. Objective: Characterize the patients with cutaneous neoplasms and other affections caused by photodamage, according to selected clinical variables. Methods: A cross-sectional, observational, clinical, descriptive and retrospective study of 64 patients diagnosed with some affection caused by photodamage was carried out, belonging to the health area of the doctor office No. 11 of Achiles Espinosa Salgado Polyclinic in Las Tunas, from January, 2020 to the same period in 2022. Some variables were analyzed, such as age, sex, color of the skin, skin photo type, occupation, regular use of solar protection means before the 18 years and now, as well as dermatologic disease caused by photodamage. Results: There was a prevalence of the 60 years and over age group (43.7 %), female sex (54.7 %), color of the skin white (98.5 %), skin photo type III (59.4 %) and the state workers (53.1 %). It was found that 90.6 % of the patients didn't have history of exhibition to non ultraviolet radiations; 25.0 % referred to use some means of protection regularly before the 18 years and 51.5 % use it at the moment. The dermatologic disease caused by photodamage that prevailed was the skin cancer (37.5 %). Conclusions: This study denoted the relevance and necessity to identify the clinical characteristics of the patients with affections caused by photodamage in the doctor office abovementioned.

Laser Q-Switched para o tratamento da melanose labial na síndrome de Peutz-Jeghers / Q-Switched Laser for the treatment of mucocutaneous pigmentation on Peutz-Jeghers Syndrome

A síndrome de Peutz-Jeghers (SPJ) é uma doença autossômica dominante, rara, em que há mutação no gene supressor tumoral, havendo maior predisposição para neoplasias, principalmente do trato gastrointestinal. As primeiras manifestações iniciam-se na infância com a presença de melanose mucocutânea e, posteriormente, surgem os pólipos hamartomatosos gastrointestinais. Apresentaremos o caso de uma paciente feminina, jovem, cujas manifestações iniciais da SPJ iniciaram-se na infância sob a forma de melanose cutânea. O tratamento dessas lesões foi realizado com três sessões com os lasers Nd:YAG Q-Switched 1064nm e KTP Q-Switched 532nm, evoluindo com excelente resposta terapêutica e sem recidiva

Peutz-Jeghers syndrome (PJS) is a rare, autosomal dominant disease where there is a mutation in the tumor suppressor gene, with a greater predisposition to neoplasms, especially of the gastrointestinal tract. The first manifestations begin during childhood with the presence of mucocutaneous melanosis and, later, gastrointestinal hamartomatous polyps. We describe a case of a young woman whose initial PJS manifestation started during her childhood with cutaneous melanosis. Three sessions with the Q-switched 1064nm Nd:YAG and 532nm KTP lasers were performed to treat the melanosis with excellent results and without recurrence.

Gene mutation analysis of a family with familial generalized lentiginosis / 中华皮肤科杂志

Objective:To analyze clinical and genetic characteristics of a family with familial generalized lentiginosis, and to identify the causative gene mutation.Methods:Clinical characteristics and inherited pattern were analyzed in a family with familial generalized lentiginosis. Peripheral blood samples were obtained from the proband, his affected father and healthy mother, and genomic DNA was extracted. PCR was performed to amplify all exons and their flanking sequences of the SASH1 gene, followed by DNA sequencing. The proband′s mother and 100 unrelated healthy controls served as controls to determine the mutation site. Previous literature and gene mutation databases were searched to rule out the possibility that the SASH1 gene mutations were single nucleotide polymorphisms, and to determine whether it was a known mutation.Results:A 4-generation family consisting of 17 members was investigated, and there were 9 patients in the family, including 7 males and 2 females. Patients existed in each generation, and the disease was inherited in an autosomal dominant manner in this family. Gene sequencing revealed a heterozygous duplication mutation c.49_54dupCCCGAG in exon 1 of the SASH1 gene in the proband and his father. This mutation was not found in his mother or healthy controls, and had not been reported in previous literature or gene mutation databases.Conclusion:The heterozygous duplication mutation c.49_54dupCCCGAG in the SASH1 gene is a pathogenic mutation for the clinical manifestations of familial generalized lentiginosis in this family.

Caracterización clínico-epidemiológica de pacientes con daño actínico crónico. Cochabamba, Bolivia / Clinical-epidemiological characterization of patients with chronic actinic damage. Cochabamba, Bolivia

RESUMEN Introducción: el daño actínico crónico es un grupo de alteraciones en la estructura, función y apariencia de la piel como resultado de la exposición no controlada a las radiaciones ultravioletas. Puede provocar el cáncer de piel. Objetivo: caracterizar a los pacientes con daño actínico crónico, atendidos en la consulta de Dermatología del Hospital Comunitario Valle Hermoso, en el departamento de Cochabamba, Bolivia. Materiales y métodos: se realizó un estudio clínico descriptivo, prospectivo, en un universo de 1 833 pacientes diagnosticados con daño actínico crónico, atendidos en la consulta de Dermatología del Hospital Comunitario Valle Hermoso, en Cochabamba, entre septiembre de 2017 y septiembre de 2018. Se evaluaron las variables edad, sexo, color y fototipo de piel, ocupación, uso de medios de protección solar, exposición a otro tipo de radiaciones, manifestaciones clínicas de fotodaño y altitud del lugar de residencia. Resultados: predominaron el grupo de edad de 25 a 59 años, el sexo femenino, el color de piel mestizo (77,08 %), el fototipo de piel IV (76,98 %) y la ocupación comerciante (72,56 %). La mayoría de los pacientes (82,7 %) no utilizaron medios de protección solar, y el 99,8 % no tuvieron exposición a otro tipo de radiaciones. Las lesiones por fotodaño que prevalecieron fueron melasma (83,03 %) y lentigos (12,22 %). El 99,29 % vivían en zonas de gran altitud. Conclusiones: se caracterizaron los pacientes con daño actínico crónico, obteniendo en algunas variables estudiadas resultados similares a los mencionados por otros investigadores (AU).

ABSTRACT Introduction: chronic actinic damage is a group of alterations in the structure, function, and appearance of the skin as a result of uncontrolled exposure to ultraviolet radiation. It can cause skin cancer. Objective: to characterize the patients with chronic actinic damage, treated at the Dermatology consultation of Valle Hermoso Community Hospital, in the department of Cochabamba, Bolivia. Materials and methods: a descriptive, prospective clinical study was conducted in a universe of 1,833 patients diagnosed with chronic actinic damage, treated at the Dermatology clinic of the Valle Hermoso Community Hospital, Cochabamba, between September 2017 and September 2018. The variables age, sex, skin color, skin phototype, occupation, use of sun protectors, exposure to other types of radiation, clinical manifestations of photodamage and altitude of the place of residence were evaluated. Results: the age group from 25 to 59 years, the female sex, mestizo skin color (77.08 %), the IV skin phototype (76.98 %) and merchant occupation (72.56 %) predominated. Most patients (82.7 %) did not use sun protection means, and 99.8 % had no other radiation exposure. The prevailing photodamage lesions were melasma (83.03 %) and lentigo (12.22 %). 99.29 % lived in high altitude areas. Conclusions: the patients with chronic actinic damage were characterized, obtaining in some variables studied results similar to those mentioned by other researchers (AU).

Mutation analysis of the PTPN11 gene in a pedigree with LEOPARD syndrome / 中华皮肤科杂志

Objective:To determine mutations in the PTPN11 gene in a family with LEOPARD syndrome.Methods:Clinical evaluation was carried out in a large pedigree with confirmed LEOPARD syndrome diagnosed in Hwa Mei Hospital, University of Chinese Academy of Sciences. Peripheral blood samples were obtained from 4 patients and 2 unaffected healthy members in the family, as well as 100 unrelated healthy controls. DNA was extracted from the blood samples, and PCR was performed to amplify all exons of the PTPN11 genes, followed by Sanger sequencing.Results:There were 14 members in 3 generations of the family, 6 of whom were affected (3 males and 3 females) , demonstrating an autosomal dominant inheritance pattern. Skin lesions were mainly distributed on the face, trunk and limbs, accompanied by special facial features and cardiovascular system abnormalities. A missense mutation c.1632G>T (p.R558L) in the PTPN11 gene was identified in the 4 patients, which resulted in the substitution of arginine by leucine at amino acid position 558. This mutation had not yet been reported previously. No mutation was detected in the PTPN11 gene in the 2 unaffected family members or 100 healthy controls.Conclusion:The missense mutation c.1632G>T in exon 13 of the PTPN11 gene may be the molecular basis for LEOPARD syndrome in this family.

Associação de luz intensa pulsada e laser Erbium: Yag 2940nm para tratamento de lentigo na face / Association of intense pulsed light and Erbium: Yag 2940 nm laser for treatment of lentigo on the face

O lentigo solar está presente em 90% da população com mais de 50 anos de idade, apresentando-se como manchas hipercrômicas em regiões fotoexpostas, que aumentam com o envelhecimento e são mais frequentes em peles claras. Há diversas modalidades terapêuticas com melhores resultados quando associadas. Descrevemos o caso de um homem de 62 anos, fototipo II de Fitzpatrick, com queixa de máculas acastanhadas em dorso nasal há oito anos. Foi submetido à biópsia de pele, e o estudo histológico confirmou ser lentigo solar. O paciente foi tratado com seis sessões de luz intensa pulsada associada a laser de Erbium: YAG 2940nm, com bom resultado clínico

Solar lentigo is present in 90% of the population over 50 years of age andcharacterizes as hyperchromic spots in photoexposed regions. It increases with aging and is more frequent in light skin. There are several therapeutic modalities, which achieve better results whenassociated. We describe the case of a 62-year-old man with Fitzpatrick skinphototype II, complaining of brownish macules in nasal dorsum for eight years. The patient underwent a skin biopsy, and the histological study confirmed solar lentigo. The patient was treated with six sessions of Intense Pulsed Light associated with Erbium-Yag2940 nm Laser with a good clinical result

Biópsia por saucerização para diagnóstico diferencial de lentigo maligno na face e no couro cabeludo: abordagem diagnóstica / Shave biopsy for differential diagnosis of lentigo maligna on the face and scalp: diagnostic approach

Introdução: O lentigo maligno é um subtipo de melanoma in situ que acomete áreas de intenso dano solar. Na face, ele pode ter aspecto clínico e dermatoscópico semelhante a diversas lesões pigmentadas benignas. O diagnóstico diferencial entre elas é fundamental para abordagem terapêutica adequada e deve, preferencialmente, ser feito pela análise histopatológica. A biópsia excisional é o padrão ouro, porém em lesões grandes, irressecáveis ou em locais de difícil abordagem ela pode gerar grande prejuízo estético e funcional. Nesses casos, a biópsia por saucerização parece ser uma alternativa segura e fidedigna. Objetivo: Descrever a técnica adequada da saucerização, discutir seus resultados e suas indicações na rotina ambulatorial do dermatologista. Métodos: Foram selecionados 16 pacientes com suspeita de lentigo maligno na face e no couro cabeludo. Os critérios de inclusão foram idade maior que 18 anos, ausência de diagnóstico e tratamentos prévios, lesões planas, maiores que 8mm e com sinais clínicos e dermatoscópicos sugestivos. A abordagem realizada foi biópsia por saucerização. Resultados: O diagnóstico de lentigo maligno foi confirmado em 25% dos casos, e a ampliação de margens apresentou resultado compatível em 100% deles. Conclusões: A biópsia por saucerização parece ser uma alternativa adequada para lesões planas sem evidências clínicas e dermatoscópicas de crescimento vertical.

Introduction: Lentigo maligna is a subtype of melanoma in situ, which affects sun-exposed areas. On the face, it can have a clinical and dermoscopic appearance similar to several benign pigmented lesions. Differential diagnosis between them is fundamental for the appropriate therapeutic and should be made by histopathological analysis. Excisional biopsy is the gold standard, but in large, unresectable lesions or in difficult anatomical sites, it can have aesthetic or functional implications. In these cases, shave biopsy appears to be a safe and reliable alternative. Objective: To describe an appropriate shave biopsy technique, discuss its results and indications in the outpatient routine of the dermatologist. Methods: Sixteen patients with suspected : Lentigo maligna on the face and scalp were selected. Inclusion criteria were older than 18 years, lack of diagnosis and previous treatment, flat lesions larger than 8 mm and suggestive clinical and dermatoscopic signs. The approach performed was shave biopsy. Results: The diagnosis of : Lentigo maligna was confirmed in 25% of the cases, and a widening of margins presented compatible results in 100% of them. Conclusions: Shave biopsy seems to be a suitable alternative for flat lesions without clinical and dermoscopic criteria of vertical growth.

Lentigo maligno tratado con imiquimod 5%. Presentación de un caso y revisión del tema / Malignant Lentigo treated with imiquimod 5%. Presentation of a case and review of the subject

Resumen El lentigo maligno (LM) es una variante de melanoma in situ que se desarrolla principalmente en áreas de exposición solar crónica en pacientes de etnia blanca, de edad media-avanzada. Sin tratamiento, del 5% hasta el35% de los LM pueden progresar a un melanoma lentigo maligno (LMM). Aunque el tratamiento de elección es quirúrgico, el imiquimod aparece como una opción no invasiva viable. Suele indicarseen pacientes con tumores de gran tamaño, personas de edad avanzada o con patología de base, o que simplemente rechazan la extirpación quirúrgica de la lesión, especialmente por ser desfigurante. Se presenta una paciente con LM tratada satisfactoriamente con imiquimod tópico.

Abstract Malignant lentigo (LM) is a variant of in situ melanoma that develops mainly in areas of chronic sun exposure in middle-aged patients. Without treatment, 5% to 50% of the LM can progress to a lentigo maligna melanoma (LMM). Although the treatment of choice is surgical, imiquimod seems to be a viable and non-invasive option in patients with large tumors, elderly or people with underlying disease, or who simply reject the surgical removal of the lesion. We present a case of LM satisfactorily treated with topical imiquimod.

Lentigo maligno palpebral: o manejo com a interface Dermatologia-Oculoplástica: a propósito de um caso / Lentigo maligna of the eyelid: management with Dermatology-Oculoplastic interface: for the purpose of a case

Apresentou-se à consulta um paciente masculino de 74 anos, portador de uma mancha hiperpigmentada junto à borda palpebral inferior esquerda, com cores variadas, entre diferentes matizes de marrom; a biópsia confirmou o diagnóstico de lentigo maligno. A sua localização na borda palpebral é rara. Há alguma divergência na literatura quanto ao melhor método para seu tratamento. Opções terapêuticas não cirúrgicas, como o imiquimode, têm sido apresentadas bem como diferentes variantes no manejo cirúrgico e nas margens requeridas. No caso descrito, optou-se por manejo com margens conservadoras, preservando-se a funcionalidade da área.

74-year-old male patient came to medical consultation presenting a hyperpigmented stain near the lower left eyelid edge, with varying colors, between different shades of brown; the biopsy confirmed the diagnosis of lentigo maligna. Its location on the eyelid edge is rare. There is some divergence in the literature regarding the best method for its treatment. Non-surgical therapeutic options, such as imiquimod, have been suggested, as well as different variants in surgical management and required margins. In the case described, it was chosen to manage with conservative margins, preserving, the functionality of the area.

Melanoma lentigo maligno amelanótico / Amelanotic lentigo maligna melanoma

RESUMEN El melanoma lentigo maligno es un subtipo de melanoma invasor, que se localiza en áreas fotodañadas de cara y cuello, manifestándose como una mácula no muy definida, de varios colores de la gama del marrón y negro. La variante amelanótica es infrecuente en cualquiera de los subtipos cutáneos de melanoma. Presentamos el caso de una mujer de 63 años, que presentó un melanoma lentigo maligno de subtipo amelanótico y de localización infrecuente, en miembro inferior.

SUMMARY Lentigomalignamelanoma is a subtype of invasive melanoma, located in photodamaged skin, particularly of the face and neck. It appears as an ill- defined macula, of heterogeneous color, ranging from brown to black. The amelanotic variant is infrequent in any of the cutaneous melanoma subtypes. We report the case of a 63-year-old woman with amelanoticlentigomaligna melanoma, located in her lower right limb.

Uso da técnica em "spaghetti" para tratamento cirúrgico do lentigo maligno / Use of the "spaghetti" technique for surgical treatment of lentigo maligna

O lentigo maligno (LM) é uma forma de melanoma in situ que mais comumente se apresenta como uma mácula de crescimento lentamente progressivo, pigmentada, na face de idosos com pele danificada pelo sol. Esse melanoma in situ tem um risco (30% a 50%) de progressão para lentigo maligno melanoma. A excisão cirúrgica completa da lesão requer margens de pelo menos 10mm, mesmo para lesões in situ. Porém, quando o crescimento de LM ocorre em áreas de implicações estéticas ou funcionais (face, pescoço, solas), a excisão é frequentemente reduzida para preservar estruturas anatômicas importantes e por razões cosméticas. Além disso, as margens periféricas podem ser clinicamente mal definidas e nem sempre pigmentadas, com extensão subestimada e risco de ressecção insuficiente. A "técnica de espaguete", descrita por Gaudy Marqueste, é uma cirurgia estratégica baseada na amostragem de uma faixa de tecido "spaghettilike" para determinar as margens da lesão antes da remoção do tumor. Após a confirmação anatomopatológica de margens livres de neoplasia, a lesão principal central é ressecada, permitindo a reconstrução do defeito no mesmo procedimento, sendo uma alternativa à cirurgia micrográfica de Mohs.(AU)

Lentigo maligna (LM) is a melanoma in situ that commonly presents as a macula with progressive and irregularly pigmented growth, especially in the face of elderly people with sun-damaged skin. This melanoma in situ has a risk (30-50%) of progression to lentigo maligna melanoma. Complete surgical excision of the lesion requires margins of at least 10 mm, even for lesions in situ. However, when the growth of LM occurs in areas of aesthetic or functional implications (face, neck, and soles), the excision is often reduced to preserve important anatomic structures and for cosmetic purposes. Moreover, the peripheral margins may be clinically ill-defined and not always pigmented, and thus, such cases are associated with underestimated extension and risk of insufficient resection. The "spaghetti" technique, described by Gaudy Marqueste, is a strategic surgical approach based on sampling of a range of "spaghetti-like" strips to determine the margins of the lesion prior to removal of the tumor. After the pathological confirmation of neoplasia-free margins, the main central lesion is resected, allowing reconstruction of the defect in the same procedure, as an alternative to Mohs micrographic surgery. (AU)

Dermoscopic features of solar lentigo, seborrheic keratosis and lichen planus-like keratosis: an expert consensus statement / 中华皮肤科杂志

Solar lentigo, seborrheic keratosis, and lichen planus-like keratosis are common benign epidermal proliferative diseases. To recognized their dermoscopic characteristics is helpful in many clinical aspects, such as making clear diagnoses, differentiating from other skin neoplasms, avoiding unnecessary biopsies or surgeries, and real-time monitoring of lesion changes. This consensus summarizes the dermoscopic characteristics of the 3 diseases. The dermoscopic features of solar lentigo include sharply demarcated borders, moth-eaten borders, faint pigment network, fingerprint-like areas, homogeneous brown pattern, pseudonetwork. The dermoscopic features of seborrheic keratosis are sharply demarcated borders, milia-like cysts, comedo-like openings, cerebriform pattern, hairpin blood vessels, moving en bloc in the wobble test. The dermoscopic features of lichen planus-like keratosis are pepper-like dots/granules, which may be surrounded by features of solar lentigo, seborrheic keratosis or actinic keratosis.

Development of Vitiligo-Like Depigmentation after Treatment of Lentigo Maligna Melanoma with 5% Imiquimod Cream

A 69-year-old man presented with a black irregular patch on his left cheek. Skin biopsy revealed lentigo maligna melanoma in situ. He was treated via partial excision of the melanoma, followed by the application of 5% imiquimod cream every other night for 6 to 8 hours. The patient experienced severe local inflammation accompanied by burning, edema, and erythema, as well as oozing and crusting. The patient discontinued using the imiquimod cream after 15 applications because of the inflammation. Depigmentation was noted in the treated area 3 months after the initiation of treatment with imiquimod cream. Histological examination using Melan-A staining of the depigmented area revealed an absence of melanocytes, which is consistent with vitiligo. The depigmented lesions improved considerably after a 5-year follow-up, and there was no recurrence of melanoma.

Clinical efficacy of Q-switched laser on pigmented dermatoses and its detection of skin physiological function / 中华医学美学美容杂志

Objective To investigate the effect of Q laser on microcirculation structure and skin barrier function of subcutaneous tissue in patients with pigmented dermatosis.Methods The Q laser was used in treatment of 100 cases of pigmented skin diseases,and the skin barrier function was detected before and after treatment in patients with lesions,including sebum content,transepidermal water loss of skin moisture;difference of skin barrier function in patients was analyzed before and after treatment;the structural change of microcirculation were observed before and after treatment of skin tissue;the clinical curative effects of patients after treatment were analyzed,and then the patients were followed up to evaluate the recurrence rate.Results After the treatment of patients with skin lesions,barrier function was compared with a significant difference.Compared with before treatment,rise,oil content of skin lesions in patients with skin moisture content,transepidermal water loss of skin moisture of the patient improved obviously after treatment.The effective rate was 94 ％ in the 100 cases of skin diseases.No hypopigmentation or scar occurred in the patients.And the follow-up showed that the recurrence rate was relatively low.Conclusions Adjusted Q laser may participate in the improvement of microcirculatory disturbances through special mechanisms,so as to regulate the skin barrier function of patients.

Melanoma in situ and syringoma: a rare collision tumor. Clinical-pathological report of a case

Abstract Collision or contiguous tumors, defined as two or more distinct tumors occurring at one site, are often an unexpected finding and may represent a diagnostic challenge, as clinical and histological presentations do not always coincide. Various combinations of collision tumors have been described with respect to melanocytic lesions, with the most frequently reported being the combination of nevus and basal cell carcinoma. We present an unusual case on the nose involving a melanoma in situ and a clinically-inapparent syringoma, which, to the best of our knowledge, is the first report of this combination.

Beneficial Effect of Low Fluence 1,064 nm Q-Switched Neodymium:Yttrium-Aluminum-Garnet Laser in the Treatment of Senile Lentigo

BACKGROUND: Low fluence 1,064 nm Q-switched (QS) Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG) laser treatment, also known as laser toning, is widely used for pigmentary disorders. There has been no reliable evaluation of the effect of low fluence 1,064 nm QS Nd:YAG laser for senile lentigo. OBJECTIVE: To investigate the beneficial effect of low fluence 1,064 nm QS Nd:YAG laser in the treatment of senile lentigo on the face. METHODS: A retrospective review was conducted on patients treated only with repetitive low fluence 1,064 nm QS Nd:YAG laser. Among them, 12 patients with multiple senile lentigines before treatment were included. All side effects were recorded to assess the safety of the modality. RESULTS: Mean age was 56.1±7.8 years old and male-to-female ratio was 1:11. Mean treatment fluence was 1.62±0.16 J/cm² and mean total treatment session was 8.8±2.6. Mean interval period between each session was 28.0±11.4 days and mean treatment session to reach marked and near total improvement was 8.7±2.8. At the final visit, seven of 12 (58.3%) patients reached marked and near total improvement, and three of 12 (25.0%) reached moderate improvement. No side effects occurred. CONCLUSION: Repetitive low fluence 1,064 nm QS Nd:YAG laser treatment may be an effective and safe optional modality for senile lentigo.

Melanoma lentiginoso acral en una paciente adulta / Acral lentiginous melanoma in an adult patient

Se presenta el caso clínico de una paciente ecuatoriana de 58 años, blanca, con antecedentes de hernias discales en regiones cervical y lumbar, quien hace 2 años asistió a la Consulta de Dermatología por presentar cambio de coloración en la uña del tercer dedo de la mano derecha, síntomas que se correspondían con un lentigo simple. En esta ocasión acude con destrucción de la lámina ungueal y aumento de la coloración que se extiende a todo el pulpejo del dedo, por lo cual se le realizó otra biopsia y se confirmó el diagnóstico histológico de melanoma lentiginoso acral (in situ).

The case report of a 58 years white patient is presented with a history of disk herniation in cervical and lumbar regions, who 2 years ago attended the Dermatology Service due to a color change in the fingernail of the third finger of her right hand, symptoms that belonged to a lentigo simplex. In this occasion she presented destruction of the ungueal bed and increase of color which covers the whole fingertip, so another biopsy was carried out and the histological diagnosis of acral lentiginous melanoma (in situ) was confirmed.

Retrospective Review of 19 Patients with Lentigo Maligna Melanoma / 대한피부과학회지

BACKGROUND: Lentigo maligna melanoma (LMM) is a subtype of melanoma that typically develops on sun-damaged skin. LMM is estimated to comprise 4~15% of melanomas, but the prevalence is known to be relatively lower in the Korean population than in the Caucasian population. OBJECTIVE: To review the clinico-pathologic features and treatment outcomes of Korean patients with LMM. METHODS: Nineteen patients diagnosed with LMM during 2003~2015, in the Yonsei University Health System, were included in this study. The age and sex of the patients, lesion location, thickness (Breslow), stage, treatment methods, BRAF, NRAS, and KIT mutation status, and survival rates were analyzed. RESULTS: Among the 19 Korean patients, 11 were male and 8 were female. The median age was 59.2 years. The most common site was the cheek (47.4%), followed by the scalp, eyelid, nose, forehead, lip, and neck. At the time of diagnosis, 13 patients were in localized stages (5 patients, stage 0; 3 patients, stage I; and 5 patients, stage II) and 6 patients were in advanced stages (3 patients, stage III; and 3 patients, stage IV). Patients in the localized stages showed better overall survival (OS) than those in the advanced stages (p=0.012). Nine patients were treated with a wide excision, and 6 using Mohs micrographic surgery. Three patients received high-dose interferon-α therapy; 6, chemotherapy; and 4, radiotherapy. Two patients in stage 0 were treated with topical ingenol mebutate. Two patients had BRAF V600E mutation; 1, NRAS G12R mutation; and 1, KIT mutation. Median OS of the patients was 40.8 months. CONCLUSION: Our analysis provides additional information about clinical characteristics, treatment, and prognosis of LMM in Korean patients.

Skin Pigmentation and Pigmentary Disorders: Focus on Epidermal/Dermal Cross-Talk

Variation in human skin and hair color is the most notable aspect of human variability and several studies in evolution, genetics and developmental biology contributed to explain the mechanisms underlying human skin pigmentation, which is responsible for differences in skin color across the world's populations. Despite skin pigmentation is primarily related to melanocytes functionality, the surrounding keratinocytes and extracellular matrix proteins and fibroblasts in the underlying dermal compartment actively contribute to cutaneous homeostasis. Many autocrine/paracrine secreted factors and cell adhesion mechanisms involving both epidermal and dermal constituents determine constitutive skin pigmentation and, whenever deregulated, the occurrence of pigmentary disorders. In particular, an increased expression of such mediators and their specific receptors frequently lead to hyperpigmentary conditions, such as in melasma and in solar lentigo, whereas a defect in their expression/release is related to hypopigmented disorders, as seen in vitiligo. All these interactions underline the relevant role of pigmentation on human evolution and biology.