[Lentigo maligna: a diagnostic and therapeutic challenge]

Area of Science:

• Dermatology
• Oncology
• Pathology

Background:

• Lentigo maligna is an early melanoma subtype commonly found on chronically sun-exposed skin.
• Diagnosing lentigo maligna is challenging due to atypical melanocyte proliferation, mimicking benign changes in sun-damaged skin.
• Accurate clinical and pathological diagnosis is crucial for effective treatment and patient outcomes.

Discussion:

• Dermoscopy and in vivo reflectance confocal microscopy (IVCM) are valuable diagnostic aids, enhancing the accuracy of clinical lentigo maligna assessment.
• These advanced imaging techniques help differentiate lentigo maligna from benign solar lentigines and other pigmented lesions.
• Improved diagnostic accuracy leads to more appropriate treatment planning and reduces the risk of under- or overtreatment.

Key Insights:

• The diagnostic difficulty of lentigo maligna stems from the overlap between malignant and benign melanocyte changes in sun-damaged skin.
• Integrating dermoscopy and IVCM into the diagnostic workflow significantly improves the ability to identify lentigo maligna accurately.
• Mohs micrographic surgery is recognized as the gold standard treatment for lentigo maligna when available, ensuring complete tumor removal with tissue preservation.

Outlook:

• Further research into non-invasive diagnostic markers could enhance early detection of lentigo maligna.
• Expanding the accessibility and training for advanced diagnostic tools like IVCM is essential.
• Continued evaluation of surgical and non-surgical treatment modalities will refine management strategies for lentigo maligna.