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.

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.

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.

Two Cases of Lentigo Maligna with Atypical Clinical Presentation / 대한피부과학회지

Lentigo maligna is a variant of melanoma in situ that appears on sun-exposed areas as a macule with variegated pigmentation and irregular borders. If untreated, it has a risk of progressing to lentigo maligna melanoma. Two patients presented with hyperpigmented macules or patches on atypical facial areas. The histological findings were consistent with lentigo maligna. An 80-year-old Korean woman presented with clustered hyperpigmented macules on the lower lip and oral mucosa, and a 45-year-old Caucasian presented with a lesion located on the external auditory meatus, with intermittent sun exposure. Herein, we report two interesting cases of lentigo maligna with atypical clinical presentations.

A Case of Lentigo Maligna and Basal Cell Carcinoma That Developed on the Face / 대한피부과학회지

Lentigo maligna (LM) is a subtype of melanoma in situ that may become lentigo maligna melanoma. LM is a pigmented lesion that most commonly occurs on sun-exposed skin inthe elderly. Intense exposure to ultraviolet light also accounts for nonmelanotic skin tumors, and particularly basal cell carcinoma (BCC). We herein report on a case of LM and BCC on the right face of a 76-year-old woman. She presented with a longstanding irregular-shaped brown to black pigmented patch on the right infra-orbital area, and a pigmented dome-shaped papule on the right nasolabial fold. The histopathologic findings were consistent with LM and BCC. We performed surgical excisions and there has been no recurrence for 10 months.

A Case of Collision Tumor Involving Squamous Cell Carcinoma and Lentigo Maligna / 대한피부과학회지

The association of contiguous or "collision" tumors in the same biopsy specimen is uncommon, but often reported in foreign literature. Although some of these associations may arise from the involvement of related cell types, most are fortuitous. There are two or more common lesions juxtaposed by coincidence. The most commonly malignant association, basal cell carcinoma and melanoma, is very difficult to diagnose clinically. In this report, we describe a 80-year-old woman with squamous cell carcinoma and lentigo maligna arising at the same site on the left cheek. To the best of our knowledge, this is the first report of collision tumor comprising squamous cell carcinoma and lentigo maligna in Korean dermatological literature.

A Case of Lentigo Maligna Melanoma Treated with Mohs Micrographic Surgery / 대한피부과학회지

Lentigo maligna melanoma and lentigo maligna are typically located on photo-exposed sites such as the head and neck, with the cheek being the most common site. Since lentigo maligna melanoma and lentigo maligna are found predominantly on such cosmetically-sensitive areas, it is critical to determine the exact histologic margin for maximal sparing of tissue and complete extirpation of the tumor. Since Mohs micrographic surgery has been recommended for tumors on cosmetically-sensitive locations where the tumor margin is indistinct, it appears to be a reasonable treatment modality for this type of tumor. We describe a case of lentigo maligna melanoma on the cheek, which was resected with Mohs micrographic surgery.

A Case of Lentigo Maligna Melanoma Treated with Mohs Surgery Adopting Lateral Based Transposition Flap / 대한피부과학회지

Lentigo maligna melanoma (LMM) is the least common type of melanoma and most commonly affects the sun-exposed skin of the elderly. We herein report a case of LMM located on the left lower eyelid of an 86-year-old woman. This female patient presented with a longstanding irregular brownish patch containing black macules consistent with LMM. There are several treatment modalities for removing the LMM lesion. However, considering the functional and the aesthetic aspect of the lower eyelid, we performed Mohs micrographic surgery to remove the lesion, and lateral based transposition flap was employed to reconstruct the resultant defect on the left lower eyelid.

A Case of Lentigo Maligna Arising from Nevocytic Nevus / 대한피부과학회지

Lentigo maligna(LM) is a pigmented lesion that occurs on the sun-exposed skin of an older patients and may become lentigo maligna melanoma(LMM). Currently the percentage of LM type melanoma appears to be increasing, and this rise has been attributed to increasing UV radiation exposure. In addition to UV radiation, estrogen and progesterone, and nonpermanent hair dyes have been proposed as risk factors. A case is a 66-year-old female with a 3 years history of pigmented patch. She had a gradually enlarging irregular bordered brown to black mottled patch on the right temple area. Histologic examination revealed atypical melanocytes along the basal layer of atrophic epidermis, arranged in solitary units and small nests. Perilesional skin showed many scattered melanophages and regressing nevus cell nests which suggested preexisting nevus underwent regressive change. On the basis of clinicopathologic examination we diagnosed this case as lenigo maligna arising from nevocytic nevus and then we removed the lesion by wide surgical excision and could not find any recurrence until now.

A Case of Lentigo Maligna Melanoma

Lentigo maligna melanoma(LMM) is the least common type of melanoma. LMM is almost exclusively located on sun-exposed skin of the head and neck. We describe a case of lentigo maligna melanoma evolved from lentigo maligna in 82-year-old man. Five years ago, the patient developed a brownish pigmented lesion on the left cheek. The lesion progressed slowly, and several months ago, a black pigmented patch was developed in the periphery of the brownish pigmented patch. Histopathologic examination of the lesions revealed findings consistent with lentigo maligna and lentigo maligna melanoma.

A Case of Lentigo Maligna Melanoma / 대한피부과학회지

Lentigo maligna melanoma(LMM) is the least common type of melanoma and most commonly affects the sun-exposed skin of the elderly. We herein report a case of LMM evolved from lentigo maligna(LM). A 71-year-old female presented with a longstanding irregular brown patch containing two black papules on the left cheek which developed 8 months ago. Histopathologic findings were consistent with LM and LMM. We performed a wide excision and dufourmental flap for reconstruction with no recurrence for 30 months. Sun exposure has been known as the most important etiologic factor for the development of malignant melanoma including LMM and the incidence has an increasing tendency. Thus, skin biopsy is recommended in the evaluation of a longstanding irregular brown patch on the face to prevent LMM.

A Case of Lentigo Maligna Melanoma / 대한피부과학회지

We report herein a case of lentigo maligna in a 60-year-old female that progressed to lentigo maligna melanoma. She had an uneven dark brownish pigmented and irregular-bordered macule on the right cheek, which gradually extended peripherally over the last 20 years and became 2.5x2.5cm in size. A dark brownish nodule developed in the inferior portion of the macule 7 months ago. The histopathologic findings were consistent with lentigo maligna and lentigo maligna melanoma. The lesion was excised with a surgical margin of 1cm and a full thickness skin graft was performed.

A Case of Lentigo Maligna Melanoma / 대한피부과학회지

Herein we report a case of lentigo maligna that evolved into lentigo maligna melanoma. Fifteen years ago, the patient developed a pigmented lesion on the right cheek. The lesion progressed slowly, and 2 months ago, a black nodular lesion was developed in the periphery of the pigmented lesion. Histopathologic examination of the lesions revealed findings consistent with lentigo maligna and lentigo maligna melanorna. She had been performed wide excision and cheek flap for reconstruction.