Authors: Lunardi Bintanjoyo, MD, Johannes F. Dayrit, MD, FPDS, Alexander R. Castillo, MD, FPDS
Introduction: Lentigo maligna (LM) is a form of melanoma in situ (MIS) occurring as a melanocytic lesion mostly on the head and neck of the elderly. It mainly affects Caucasians and is associated with light skin color. The occurrence of LM in Asians is rare. This report highlights the occurrence of lentigo maligna in an elderly Filipino male with Fitzpatrick skin phototype IV.
Case Summary: A 71-year-old Filipino male presented with a 3-year history of solitary asymptomatic brown patch on the right cheek, gradually increasing in size and intensity of pigmentation. Patient worked as warehouse supervisor with little occupational sun exposure, but often had recreational sun exposure due to his fishing hobby. Physical examination showed a 1.5 cm x 1.5 cm ill-defined irregularly-shaped asymmetric brown-to-black patch on the right cheek. Dermoscopy showed rhomboidal structures with asymmetric perifollicular opening and multiple black dots. Histological examination showed focal atrophy of the epidermis, basal cell hyperpigmentation and presence of atypical melanocytes at the dermo-epidermal junction. Some of the atypical melanocytes are also found lining up the follicular infundibulum. Focal pagetoid spread is seen. The dermis reveals solar elastosis, numerous pigment-laden macrophages and a sparse perivascular inflammatory infiltrate of lymphocytes. Diagnosis of lentigo maligna was made. Patient was treated with carbon dioxide laser ablation.
Conclusion: LM is the most frequent type of MIS, developing in individuals older than 40 years and linked to cumulative ultraviolet radiation exposure. LM presents as a patch with shades of dark to tan pigmentation on actinic-damaged skin, most commonly on the cheek. Dermoscopy revealed characteristic rhomboidal structures and asymmetric perifollicular openings. Histopathology showed atrophy of the epidermis, confluent proliferation of atypical melanocytes along the dermoepidermal junction with minimal pagetoid spread, extending to the adnexal structures, and extensive solar elastosis in the dermis. Surgical excision continues to be the treatment of choice for LM. Laser ablation with carbon dioxide has not been a first-line treatment. However it may be beneficial for LM in cosmetically significant locations and owing to its short duration and minimal morbidity in predominantly aging population of LM. LM may develop into LMM in 5% of cases.
Bintanjoyo, L, Dayrit, J. & Castillo, A. (2017). A case of lentigo maligna melanoma in an elderly filipino man. Journal of the Philippine Dermatological Society, 26(2), 71-73.
lentigo maligna, Filipino skin, melanocytic lesions
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