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Giornale Italiano di Dermatologia e Venereologia 2020 April;155(2):179-89

DOI: 10.23736/S0392-0488.18.06003-0

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Lentigo maligna: diagnosis and treatment

Erika V. DE LUCA ✉, Francesca PERINO, Alessandro DI STEFANI, Valeria COCO, Barbara FOSSATI, Ketty PERIS

Institute of Dermatology, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy

Lentigo maligna (LM) is an in situ subtype of melanoma, clinically presenting as a pigmented, asymmetric macule that originates mostly on the head and neck and spreads slowly. The diagnosis may be challenging both for clinicians and pathologists. Dermatoscopy and reflectance confocal microscopy represent a useful tool in the differentiation of LM from other pigmented lesions, such as pigmented actinic keratosis, solar lentigines, seborrheic keratosis and lichen planus-like keratosis. Moreover, those non-invasive diagnostic technique may be crucial in the selection of optimal biopsy sites in equivocal lesions, in pre-surgical mapping and in evaluating and monitoring response to non-surgical treatments. Histologic examination remains the gold standard for the diagnosis of LM, showing a lentiginous proliferation of basal atypical melanocytes on a severe sun-damaged skin. The management of LM is constantly evolving. Treatments include surgery (the first choice, when available), radiotherapy and imiquimod cream (in patients not candidates to surgery). Many other possible treatments for LM have been tested, but they are not yet supported by strong evidences. We collected current guidelines and PubMed available reviews, studies and case-reports in order to make an overview on diagnosis and treatment of LM.

KEY WORDS: Hutchinson’s melanotic freckle; Melanoma; Dermoscopy; Therapeutics