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Lentigo Maligna: Clinical Presentation and Appropriate Management.

Helena Iznardo1, Cristina Garcia-Melendo1, Oriol Yélamos1,2

  • 1Dermatology Service, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.

Clinical, Cosmetic and Investigational Dermatology
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Lentigo maligna (LM) and lentigo maligna melanoma (LMM) are challenging skin cancers. This review covers their diagnosis, treatment, and management, highlighting difficulties and advanced techniques for better patient outcomes.

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Mohs surgerydermatoscopydermoscopyimiquimodlentigo malignalentigo maligna melanomamelanomareflectance confocal microscopystaged excision

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Area of Science:

  • Dermatology
  • Oncology
  • Pathology

Background:

  • Lentigo maligna (LM) is a melanoma in situ with potential to progress to invasive lentigo maligna melanoma (LMM).
  • Both LM and LMM present diagnostic and management challenges due to overlapping features with benign lesions and location on cosmetically sensitive areas.
  • Prognosis for LM is generally good, while LMM's prognosis is similar to other invasive melanomas based on Breslow thickness.

Purpose of the Study:

  • To comprehensively review published data on the diagnosis, treatment, and management of LM and LMM.
  • To highlight the diagnostic complexities and challenges in managing these challenging skin conditions.
  • To discuss current and specialized treatment approaches for LM/LMM.

Main Methods:

  • Extensive review of published literature on LM and LMM.
  • Analysis of diagnostic criteria, clinical, dermoscopic, and pathological features.
  • Evaluation of various treatment modalities and their efficacy.

Main Results:

  • Diagnostic criteria for LM/LMM are not well-established, with significant overlap with benign pigmented lesions.
  • Lesion border identification is difficult due to common occurrence in photodamaged skin.
  • Specialized surgical and image-guided treatments (e.g., margin-controlled surgery, confocal microscopy) are being developed for challenging cases.
  • Non-surgical treatments like cryosurgery, imiquimod, radiotherapy, and photodynamic therapy have been proposed, but recurrence rates are common.

Conclusions:

  • LM/LMM are complex dermatological entities requiring careful diagnosis and management.
  • Advanced techniques like margin-controlled surgery and image-guided treatments offer promising solutions for difficult-to-manage lesions.
  • Further research is needed to establish definitive diagnostic criteria and optimize treatment strategies to minimize recurrence.