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Diagnostic and Therapeutic Techniques in Lentigo Maligna: An Update
FR-Lentigo maligno, actualización en técnicas diagnósticas y terapéuticas
H. Collgros
, N. Lamas-Doménech
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Departamento de Dermatología, Hospital Universitari Sagrat Cor, Barcelona, Spain
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Collgros, N. Lamas-Doménech" "autores" => array:2 [ 0 => array:4 [ "nombre" => "H." "apellidos" => "Collgros" "email" => array:1 [ 0 => "helenacollgros@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "N." "apellidos" => "Lamas-Doménech" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento de Dermatología, Hospital Universitari Sagrat Cor, Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "FR-Lentigo maligno, actualización en técnicas diagnósticas y terapéuticas" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Lentigo maligna (LM), an in situ lesion, and lentigo maligna melanoma (LMM), which invades the dermis, constitute a diagnostic and therapeutic challenge.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Differential diagnosis includes seborrheic keratosis, solar lentigo, lichenoid keratosis, actinic keratosis, and pigmented actinic keratosis. Dermoscopic criteria may assist in the diagnosis of LM and LMM, but lack full sensitivity and specificity. While histologic diagnosis is the gold standard, atypical melanocytes are rare and sparsely distributed in these two conditions. LM is thus difficult to distinguish from melanocytic hyperplasia in photodamaged skin, and lesion margins are hard to define. Some authors have recently highlighted the importance of questioning any histopathological diagnosis of junctional nevus, dysplastic nevus, or atypical lentiginous nevus for lesions occurring in photodamaged skin on the face and neck. Nevi in this area are typically papule-type lesions of the same color as adjoining skin, but are clinically different from LM. Any of the above nevus diagnoses may underestimate an LM lesion as a benign junctional melanocytic proliferation.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> Immunohistochemistry can be of use in these equivocal cases. Typical markers include S-100, human melanoma black-45 antigen (HMB-45), melan-A (MART-1), and microphthalmia-associated transcription factor (MITF), all of which are highly sensitive to melanocytes. However, these markers fail to differentiate melanocytic nevi from melanoma lesions; P16 protein expression and proliferation markers Ki-67 and pHH-3 help with this. Identification of specific mutations in the <span class="elsevierStyleItalic">BRAF</span>, <span class="elsevierStyleItalic">NRAS</span> and <span class="elsevierStyleItalic">KIT</span> genes may be of use, especially given the recent availability of targeted drugs.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Reflectance confocal microscopy (RCM) was introduced to improve diagnostic accuracy, define the extent of a lesion, and detect recurrences. RCM allows the performance of what might be termed an in vivo optical biopsy with no need for surgery. There is a published diagnostic algorithm with 93% sensitivity and 82% specificity,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> and RCM is particularly useful for distinguishing facial LM from benign pigmented macules without the need for a biopsy.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> Moreover, presurgical mapping may help reduce positive-margin rates and recurrence rates.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The treatment of choice for LM and LMM is surgical excision. Several authors have indicated that 5-mm margins may be inadequate for LM, particularly owing to amelanotic spread on the periphery of the lesion; 9-mm resection margins are recommended instead.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> Mohs micrographic surgery is more precise than excision and has a lower recurrence rate (0%-6.25%). Certain cases may be selected for second-line treatments such as imiquimod, radiotherapy, and cryosurgery. A review of radiotherapy for LM found a recurrence rate of 5% and a rate of only 1.4% for progression to LMM.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> The authors recommend mapping the lesion first with RCM and irradiating the lesion area plus a 1-cm margin of healthy skin at a depth of 5<span class="elsevierStyleHsp" style=""></span>mm to ensure irradiation of hair follicle melanocytes. They highlight the presence of blue-gray pigmentation after treatment and the fact that RCM can distinguish this coloring from persistent or recurrent LM.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Developing a familiarity with new imaging techniques and therapeutic options for LM and LMM is important in order to offer our patients greater diagnostic accuracy and appropriate treatments, and to meet current growing demand for noninvasive, cosmetically acceptable techniques.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-06-17" "fechaAceptado" => "2014-08-10" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec460440" "palabras" => array:5 [ 0 => "Lentigo maligna" 1 => "Diagnosis" 2 => "Treatment" 3 => "Reflectance confocal microscopy" 4 => "Imiquimod and radiotherapy" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Collgros H, Lamas-Doménech N. FR-Lentigo maligno, actualización en técnicas diagnósticas y terapéuticas. Actas Dermosifiliogr. 2015;106:135–136.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Flat pigmented macules on sun-damaged skin of the head/neck: Junctional nevus, atypical lentiginous nevus, or melanoma in situ?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "I. Zalaudek" 1 => "C. Cota" 2 => "G. Ferrara" 3 => "E. Moscarella" 4 => "P. Guitera" 5 => "C. 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| 2020 Junio | 21 | 15 | 36 |
| 2020 Mayo | 18 | 20 | 38 |
| 2020 Abril | 31 | 18 | 49 |
| 2020 Marzo | 26 | 19 | 45 |
| 2020 Febrero | 1 | 3 | 4 |
| 2020 Enero | 3 | 0 | 3 |
| 2019 Diciembre | 10 | 4 | 14 |
| 2019 Noviembre | 4 | 1 | 5 |
| 2019 Octubre | 0 | 1 | 1 |
| 2019 Septiembre | 4 | 0 | 4 |
| 2019 Agosto | 4 | 4 | 8 |
| 2019 Julio | 4 | 2 | 6 |
| 2019 Junio | 4 | 6 | 10 |
| 2019 Mayo | 6 | 11 | 17 |
| 2019 Abril | 2 | 12 | 14 |
| 2019 Marzo | 4 | 12 | 16 |
| 2019 Febrero | 2 | 1 | 3 |
| 2019 Enero | 2 | 2 | 4 |
| 2018 Diciembre | 2 | 4 | 6 |
| 2018 Noviembre | 1 | 8 | 9 |
| 2018 Octubre | 4 | 0 | 4 |
| 2018 Septiembre | 5 | 0 | 5 |
| 2018 Agosto | 0 | 3 | 3 |
| 2018 Julio | 0 | 5 | 5 |
| 2018 Junio | 0 | 3 | 3 |
| 2018 Mayo | 0 | 12 | 12 |
| 2018 Marzo | 0 | 2 | 2 |
| 2018 Febrero | 43 | 3 | 46 |
| 2018 Enero | 34 | 9 | 43 |
| 2017 Diciembre | 48 | 8 | 56 |
| 2017 Noviembre | 19 | 1 | 20 |
| 2017 Octubre | 27 | 7 | 34 |
| 2017 Septiembre | 12 | 6 | 18 |
| 2017 Agosto | 14 | 7 | 21 |
| 2017 Julio | 13 | 10 | 23 |
| 2017 Junio | 24 | 6 | 30 |
| 2017 Mayo | 21 | 18 | 39 |
| 2017 Abril | 20 | 9 | 29 |
| 2017 Marzo | 25 | 43 | 68 |
| 2017 Febrero | 17 | 10 | 27 |
| 2017 Enero | 13 | 15 | 28 |
| 2016 Diciembre | 25 | 12 | 37 |
| 2016 Noviembre | 26 | 16 | 42 |
| 2016 Octubre | 23 | 20 | 43 |
| 2016 Septiembre | 0 | 4 | 4 |
| 2016 Agosto | 0 | 1 | 1 |
| 2016 Julio | 8 | 2 | 10 |
| 2016 Junio | 19 | 0 | 19 |
| 2016 Mayo | 21 | 7 | 28 |
| 2016 Abril | 15 | 1 | 16 |
| 2016 Marzo | 11 | 1 | 12 |
| 2016 Febrero | 6 | 2 | 8 |
| 2016 Enero | 10 | 1 | 11 |
| 2015 Diciembre | 11 | 2 | 13 |
| 2015 Noviembre | 10 | 4 | 14 |
| 2015 Octubre | 6 | 7 | 13 |
| 2015 Septiembre | 2 | 0 | 2 |
| 2015 Agosto | 0 | 4 | 4 |
| 2015 Julio | 5 | 7 | 12 |
| 2015 Junio | 17 | 4 | 21 |
| 2015 Mayo | 16 | 9 | 25 |
| 2015 Abril | 4 | 10 | 14 |
| 2015 Marzo | 6 | 4 | 10 |
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