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Lentigo maligna melanoma

Lentigo maligna melanoma



Overview

Lentigo maligna melanoma (LMM) is an invasive skin cancer that develops from lentigo maligna (LM), a non-invasive form (melanoma in situ) on chronically sun-damaged skin, typically the face or neck of older adults, appearing as a slow-growing, irregularly pigmented patch that eventually deepens, requiring surgical removal to prevent spread, with Mohs surgery often preferred for its location

Symptoms

Initial Stage (Lentigo Maligna - In Situ):

Flat Patch: A flat, tan, brown, or sometimes pink patch on sun-damaged skin (face, ears, arms).

Irregular Borders: Uneven, scalloped edges.

Varied Color: Multiple shades of brown, black, or even blue.

Slow Growth: Grows outward over years, like a large freckle.

Progression to Melanoma (Invasive):

Color Change: Deepens to dark brown or black.

Texture Change: Becomes raised, developing a nodule or blue-black bump.

Changes in Sensation: May start to itch, bleed, crust, or ooze, though it's often asymptomatic early on. 

Causes

Chronic UV Exposure: The main driver is cumulative lifetime UV exposure, leading to DNA damage in melanocytes, unlike other melanomas linked to intense, intermittent sun exposure. 

Risk Factors

UV Exposure: Chronic, long-term sun exposure, not just intermittent intense exposure, is strongly linked to LMM.

Age: It's more common in older adults due to accumulated sun damage.

Skin Type: Fair skin that freckles or burns easily, blond/red hair, blue/green eyes.

Sun Spots (Solar Lentigines): A tendency to develop many sun spots (lentigines) is a significant risk factor.

Sunburns: A history of severe, blistering sunburns, especially in childhood.

Location: Occurs on chronically sun-exposed areas like the face, head, and neck.

History: Previous non-melanoma skin cancers or other skin damage.

Family History: A family history of melanoma. 

Diagnosis

Clinical Examination: Doctors look for large, flat patches on sun-exposed skin (face, neck) with irregular borders, varied colors (tan, brown, black, pink), and slow growth.

Dermoscopy: Magnified skin examination reveals specific patterns:

Follicular involvement: Irregularly pigmented follicular openings.

Annular-granular pattern: Gray dots/fine globules around follicles.

Rhomboidal structures: Diamond-shaped pigmented areas.

Reflectance Confocal Microscopy (RCM): A laser-based, non-invasive microscope that provides cellular-level views, helping map lesion edges before biopsy.

Wood's Lamp: Helps visualize lesion borders better under UV light.

Biopsy (Gold Standard): A tissue sample is taken and examined by a pathologist, confirming the diagnosis and identifying invasion (LMM vs. LM in situ). 

Treatment

Surgical Treatments (Gold Standard)

Wide Local Excision (WLE): Standard excision with healthy skin margins (5-10mm), but risk of recurrence due to subclinical spread.

Mohs Micrographic Surgery (MMS): Excises tissue layer by layer, mapping tumor extent for highest clearance and minimal tissue removal, ideal for head/neck lesions.

Staged Excision: Removing tissue in stages to confirm clear margins before final closure. 

Non-Surgical Treatments (For select patients)

Radiotherapy: Superficial X-rays or Grenz rays offer good local control, particularly for older patients or difficult locations, with good cosmetic results.

Imiquimod Cream: A topical immune response modifier, often used off-label, showing promise but less evidence than surgery/radiation.

Cryotherapy, Laser Therapy, Photodynamic Therapy: Other destructive methods used, but with less robust data. 

Type of Doctor Department :A dermatologist

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