Lentigo maligna melanoma C43.L

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

lentiginous melanoma; lentigo maligna melanoma; Lentigo maligna melanoma; Malignant melanoma at the base of a melanosis circumscripta praecancerosa

Definition
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Malignant melanoma of elderly people in chronically sun-exposed skin areas. Origins from its precursor lesion, the lentigo maligna.

Localization
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Especially face, lateral neck parts, décolleté, lower legs, forearms.

Clinical features
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Brown or brown-black, 0.2-5.0 cm in size (rarely > 5.0 cm), usually bizarrely limited, brown to brown-black, variably coloured plaque (no stain: a stain is not palpable, a plaque is characterized by a papabele raised appearance). The lentigo maligna melanoma develops chronically, "almost unnoticed" on the floor of a lentigo maligna, which usually exists for years.
With increasing duration of the melanoma, the formation of intralesional nodules can occur. This usually differs from the surrounding area in consistency and colour (black).

Further diagnostics:

Histology
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Mostly atrophic surface epithelium. Differently pronounced actinic elastosis. Noticeable are an initially linear basal compression and the later occurring nestlike aggregation of atypical pigmented melanocytes. Individual atypical melanocytes are found in higher epithelial layers. A dense linear colonization of the hair follicular epithelium is regularly found. In plaque-shaped or nodular areas the basement membrane is broken through by melanocyte nests, so that tumor aggregates of varying density can be found in the dermis.

Therapy
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  • Different guidelines apply to the surgical therapy of lentigo-maligna melanoma than for other malignant melanomas.
  • In this type of melanoma, the safety margin recommended for other malignant melanomas can often not be adhered to for cosmetic or general medical reasons in cases of advanced age, multimorbidity or problematic localisation (eyelid, nose, cheek), in tumours with a tumour thickness of Breslow > 1.0 mm.
  • The situational operative measure will have to be adapted to acceptable safety distances. In this context, a 3D histology with immunohistological edge control is mandatory in order to create an R0 situation with a reduced safety margin. The study situation justifies this procedure (no increased local recurrence, no reduced survival rate).

Progression/forecast
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Due to the late metastasis, the prognosis is more favourable than for other types of melanoma. 5-JWR=80%.

Literature
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  1. Moehrle M et al (2006) Conventional histology vs. three-dimensional histology in Lentigo maligna melanoma. Br J Dermatol 154: 453-459
  2. AWMF(2013) Guideline Program; S3 Guideline "Melanoma Diagnosis, Therapy and Follow-Up Care. www.derma.de.

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020