RESUMO
BACKGROUND: There are no well-defined clinical factors to predict the risk of occult invasion in melanoma of the lentigo maligna type (LM) before complete histopathologic analysis. OBJECTIVE: To evaluate whether clinical size was a predictor of invasion in LM and subclinical extension. METHODS: Consecutive cases of LM were recorded in a prospectively maintained database from 2006 to 2019. Patient and tumor data were recorded during initial evaluation. The LM clinical area was calculated in square millimeters (length × width). All patients were treated with staged excision. RESULTS: We included 600 patients. The mean age was 65.9 years (standard deviation, 12.3; range, 27-95 years); 62.8% (n = 377) were men. The mean LM clinical area was 128.32 mm2 for in situ lesions versus 200.14 mm for invasive lesions (P = .1). Based on quantile regression, the median margin required for complete removal increased with LM clinical area. LIMITATIONS: The study was performed in a tertiary cancer center with possible referral bias and more complex cases. CONCLUSIONS: LM can present with variable clinical size, which may correlate with subclinical extension; however, the presence of invasion is not well estimated by LM clinical area.
Assuntos
Sarda Melanótica de Hutchinson/diagnóstico , Cirurgia de Mohs , Neoplasias Cutâneas/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Feminino , Humanos , Sarda Melanótica de Hutchinson/patologia , Sarda Melanótica de Hutchinson/cirurgia , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Invasividade Neoplásica/diagnóstico , Prognóstico , Estudos Prospectivos , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia , Carga TumoralRESUMO
The importance of dermoscopy for diagnosing lentigo maligna melanoma (LMM) is well known. More recently, dermoscopy has been proposed as a useful tool also for the treatment choice and monitoring. Herein, we present an 87-year-old woman, who was successfully treated with imiquimod 5% cream after surgical persistence of residual LMM and for whom dermoscopy was helpful to assist diagnosis and assess tumor persistence after surgery and its response to topical treatment with imiquimod.
Assuntos
Dermoscopia/métodos , Sarda Melanótica de Hutchinson/diagnóstico , Sarda Melanótica de Hutchinson/terapia , Imiquimode/uso terapêutico , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/terapia , Adjuvantes Imunológicos/uso terapêutico , Administração Tópica , Idoso de 80 Anos ou mais , Terapia Combinada , Procedimentos Cirúrgicos Dermatológicos/métodos , Feminino , Humanos , Sarda Melanótica de Hutchinson/patologia , Cuidados Pré-Operatórios/métodos , Prognóstico , Medição de Risco , Neoplasias Cutâneas/patologia , Resultado do TratamentoRESUMO
BACKGROUND: Pigmented actinic keratosis (PAK) is a frequent simulator of lentigo maligna (LM) on the face upon clinical and dermoscopic examination, leading to misdiagnosis and unnecessary excisions. LM and PAK share dermoscopic features, making it difficult to have a confident diagnosis of PAK only with current dermoscopic knowledge. OBJECTIVE: We sought to evaluate sensitivity, specificity, and interobserver reproducibility of a novel dermoscopic feature, inner gray halo (IGH), and establish its histopathological and confocal correlations. METHODS: Dermoscopists blinded to histopathological diagnosis evaluated 58 PAK and 21 LM for the presence of IGH and dermoscopy parameters. Areas exhibiting IGH were marked and imaged with reflectance confocal microscopy before sampling for histopathologic correlation. Reflectance confocal microscopy and transverse histologic sectioning were performed in 14 of 79 cases. RESULTS: IGH was present in 53 of 58 (94.1%) PAK and in 5 of 21 (23.8%) LM in our series (sensitivity 91.4%; specificity 71.4%; positive predictive value 89.8%). Interobserver agreement was excellent (Kappa 0.846). Through transverse and perpendicular histologic sections, a dermoscopic-histologic-confocal correlation of IGH was established. LIMITATIONS: A larger test set is needed to further validate the use of IGH in the differential diagnosis of PAK and facial pigmented lesions. CONCLUSION: IGH is a novel dermoscopic parameter useful for the differentiation of PAK from LM on the face.
Assuntos
Sarda Melanótica de Hutchinson/diagnóstico , Hiperpigmentação/diagnóstico , Ceratose Actínica/diagnóstico , Lesões Pré-Cancerosas/patologia , Neoplasias Cutâneas/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha , Brasil , Estudos de Coortes , Intervalos de Confiança , Dermoscopia/métodos , Diagnóstico Diferencial , Face , Feminino , Humanos , Sarda Melanótica de Hutchinson/patologia , Sarda Melanótica de Hutchinson/ultraestrutura , Hiperpigmentação/patologia , Imuno-Histoquímica , Ceratose Actínica/patologia , Masculino , Microscopia Confocal , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/ultraestruturaRESUMO
La diferenciación clínica de máculas pigmentadas en rostro puede ser dificultosa. No es raro el diagnóstico de malignidad en lesiones clínicamente triviales. Además, en esta localización la dermatoscopía presenta criterios específicos debido a la histología particular observada en zonas fotoexpuestas. Objetivos: Describir las características dermatoscópicas observadas en máculas pigmentadasen rostro de pacientes vistos en el Servicio de Dermatología del Hospital Privado de Córdoba. Determinar la sensibilidad y especificidad de la dermatoscopía para el diagnósticode máculas pigmentadas en rostro. Investigar la frecuencia de hallazgos sugestivos de lentigo maligno (LM) en otras máculas pigmentadas de la cara.Materiales y Métodos: Se diseñó un estudio de diagnóstico, observacional, transversal, prospectivo y descriptivo. Se incluyeron todos los pacientes mayores de 15 años con máculas pigmentadas en rostro que fueron atendidos en el servicio de Dermatología del Hospital Privado de Córdoba durante el período de un año. Resultados: Se incluyeron 53 pacientes y 56 máculas pigmentadas. Los criterios dermatoscópicos más frecuentes fueron los puntos/glóbulos grises, los puntos/glóbulos oscuros, las áreas homogéneas claras y las aperturas foliculares asimétricas. Los criterios mássensibles y específicos para el diagnóstico de LM fueron las áreas homogéneas oscuras, las líneas oscuras, las aperturas foliculares asimétricas y las estructuras romboidales.Conclusión: No se encontró un único criterio dermatoscópico que sea específico de lentigo maligno/lentigo maligno melanoma (LM/LMM). Se alcanzó una máxima sensibilidady especificidad al combinar 3 ó 4 criterios...
Assuntos
Humanos , Sarda Melanótica de Hutchinson/diagnóstico , Sarda Melanótica de Hutchinson/patologia , Neoplasias Cutâneas/cirurgia , Neoplasias Cutâneas/diagnósticoRESUMO
El melanoma cutáneo es una neoplasia maligna potencialmente mortal, que en los últimos años ha tenido un importante aumento en su incidencia, no habiéndose establecido factores de riesgo claros que expliquen esta situación. Su pronóstico guarda estrecha relación con el diagnóstico oportuno en un estado precoz. En este artículo se revisan los factores de riesgo de esta enfermedad, los distintos tipos de melanoma, las bases del diagnóstico, la estadificación actualmente más aceptada y las principales tendencias en su manejo y tratamiento con especial énfasis en los melanomas localizados
Assuntos
Humanos , Melanoma/patologia , Neoplasias Cutâneas/patologia , Metástase Neoplásica/patologia , Estadiamento de Neoplasias/estatística & dados numéricos , Sarda Melanótica de Hutchinson/diagnóstico , Fatores de RiscoRESUMO
Lentigo maligna (LM) is a pigmented lesion that occurs on the sun-exposed skin, particularly the head and neck areas, of an older patient. The lesion increases in size and at some point, often many years after its onset, may become lentigo maligna melanoma (LMM). For this reason, most authors consider LM a form of melanoma in situ. Treatment includes surgical or destructive modalities; the preferred form of therapy is surgical removal. Histopathologic features include a proliferation of atypical melanocytes along the basal layer of the epidermis and adnexal structures. This article discusses the clinical, histopathologic, and epidemiologic features of LM. The prognosis and treatment of LM are reviewed. Although the lifetime risk of the development of LMM is unclear, LMM is discussed briefly.