Desmoplastic melanoma arising in lentigo maligna: Implications for general practice

Area of Science:

• Dermatology
• Oncology

Background:

• Lentigo maligna (LM) is a common clinical presentation in general practice.
• LM may appear stable but can harbor invasive melanoma, especially the desmoplastic subtype.

Purpose of the Study:

• To emphasize the risk of invasive melanoma within LM.
• To highlight the importance of surgical excision and multidisciplinary referral for LM management.

Main Methods:

• Case presentation of an 82-year-old male with extensive scalp LM.
• Multiple shave biopsies initially showed only in situ disease.
• Complete surgical excision revealed a focal desmoplastic melanoma.

Main Results:

• Invasive desmoplastic melanoma (Breslow thickness 5.5 mm) was found upon complete excision.
• The invasive component was subclinical and missed by prior biopsies.
• Undertreatment with non-surgical options like imiquimod or radiotherapy poses significant risks.

Conclusions:

• Surgical excision is the gold standard for managing LM with potential for invasive melanoma.
• General practitioners are vital in identifying cases requiring specialist referral.
• Non-surgical treatments may lead to undertreatment of invasive disease.