Comparison of Melanocyte Density Counts in Topical Imiquimod-Treated Skin Surrounding Lentigo Maligna vs Control Biopsy Specimens

Flores, Shadai; Luby, Nathan J.; Bowen, Glen M.

doi:10.1001/jamadermatol.2017.5632

Cited by 11 publications

(13 citation statements)

References 6 publications

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“…Additionally, the photodamaged skin samples were also taken at least 2 cm from the primary lesion in order to avoid any potential field effect . Despite using a different study design (ie, formalin‐fixed, paraffin‐embedded tissue, and nuclear staining), our findings of a statistically significant difference in melanocytic density in photodamaged and JLMP/MIS were concurrent with those from previous studies . What differed from previous studies was our range of melanocytic density.…”

Section: Discussionsupporting

confidence: 74%

Is melanocyte density our last hope? Comparison of histologic features of photodamaged skin and melanoma in situ after staged surgical excision with concurrent scouting biopsies

et al. 2019

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Differentiating melanocytic hyperplasia (MH) on photodamaged skin from junctional lentiginous melanocytic proliferations (JLMP), early evolving melanoma in situ (MIS), or the periphery of a lesion of MIS on staged excision can be challenging. Although previous cross-sectional studies have elucidated important criteria for distinguishing MH on photodamaged skin from more concerning lesions, this study highlights a technique to treat JLMP and MIS with staged mapped excision and baseline scouting biopsies of adjacent nonlesional photodamaged skin to assist in determination of surgical margin clearance. Additionally, we compare the lesional and photodamaged control biopsies from the same patient to evaluate relevant histologic criteria that may be used to distinguish MH in photodamaged skin from JLMP/MIS, while minimizing confounding factors. There was a statistically significant difference (P ≤ 0.05) found for melanocyte density, irregular melanocyte distribution, melanocyte clustering, follicular infundibulum involvement, and nesting. However, criteria such as nesting, epithelioid cells and melanocyte clustering were seen in both photodamaged skin and MIS. These findings underscore the fact that histologic features of photodamaged skin can overlap with the histopathological features of MIS. Of all of the criteria evaluated, melanocytic density was the most objective histologic criterion and did not show overlap between the sun-damaged and JLMP/MIS groups. K E Y W O R D S atypical junctional melanocytic hyperplasia, lentigo maligna, melanoma in situ, scouting biopsy, slow Mohs, staged excision How to cite this article: Speiser J, Tao J, Champlain A, et al. Is melanocyte density our last hope? Comparison of histologic features of photodamaged skin and melanoma in situ after staged surgical excision with concurrent scouting biopsies.

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Section: Discussionsupporting

confidence: 74%

Is melanocyte density our last hope? Comparison of histologic features of photodamaged skin and melanoma in situ after staged surgical excision with concurrent scouting biopsies

et al. 2019

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“…38,39 Moreover, other samples were taken as control biopsies near the lesion but from a clearly unaffected marginal area. 25,27,29,40 The methods of melanocyte counting were also different. In several studies, more than 1 observer examined the slides, 27,29,30,32,35,38,39 while in others, there was only one.…”

Section: Discussionmentioning

confidence: 99%

“…25,27,29,40 The methods of melanocyte counting were also different. In several studies, more than 1 observer examined the slides, 27,29,30,32,35,38,39 while in others, there was only one. 18,19,25,26,31 Similarly, the selection of sections used for counting differed.…”

Section: Discussionmentioning

confidence: 99%

Melanocyte Density in the Diagnosis of Melanoma In Situ in Sun-Damaged Skin

Löper,

Schön,

Mitteldorf

2024

The American Journal of Dermatopathology

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Histologic differentiation between melanoma in situ in chronically sun-damaged skin (CSDS) [lentigo maligna (LM)] and CSDS without malignancy is difficult because signs of melanocyte activation and proliferation are found in both. A potentially reliable and quantifiable criterion is melanocyte density (MD). Here, we evaluated whether and to what extent MD allows the distinction between LM and CSDS, which is particularly relevant for the evaluation of borderline cases and surgical margins. Articles assessing MD in LM and/or CSDS were evaluated in a systematic review. The results were categorized and compared according to staining. Cutoff values were included whenever stated. Twenty articles matched the selection criteria. Six hundred forty-four samples of CSDS and 227 samples of LM were considered. In each individual study, mean MD scores were higher for LM than for CSDS. However, looking at the overall study situation, it becomes clear that the data are very heterogeneous and show overlaps. Therefore, no reliable orientation value can be derived. Only 1 article defined a cutoff value. The data of MD in LM in contrast to CSDS were sparse, and a defined cutoff value was only mentioned in 1 article for microphthalmia-associated transcription factor, which cannot yet be generalized. Especially regarding the importance for the definition of surgical resection margins, this unsatisfactory data set highlights the need for further studies. More precise diagnostic criteria could spare some patients extensive and possibly disfiguring surgery.

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“…18 Seven open-labelled studies evaluated imiquimod in the neoadjuvant treatment of LM. 15,[18][19][20][21][22][23][24] All demonstrated an extra-lesional excision rate ranging from 78% to 100% with imiquimod (Supplementary data: Table S2).…”

Section: Discussionmentioning

confidence: 99%

Efficacy of imiquimod in the management of lentigo maligna

Daude

Dinulescu

Nguyen

et al. 2023

Acad Dermatol Venereol

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BackgroundLentigo maligna (LM) is a melanocytic proliferation occurring on photo‐exposed skin that may progress to LM melanoma. Surgery is recommended as first‐line treatment. Excision margins of 5–10 mm remain, without international consensus. Several studies have shown that imiquimod, an immunomodulator, induces LM regression. This study investigated the effect of imiquimod versus placebo in neoadjuvant settings.Patients and MethodsWe performed a prospective, randomized, multicentre, phase III clinical study. Patients were randomly assigned in 1:1 ratio to receive imiquimod or placebo for 4 weeks, followed by LM excision 4 weeks after the last application of imiquimod or placebo. The primary endpoint was extra‐lesional excision, with a 5 mm margin from the residual pigmentation after imiquimod or vehicle. Secondary endpoints included the gain on the surface removed between the two groups; number of revision surgeries to obtain extra‐lesional excisions; relapse‐free time; and number of complete remissions after treatment.ResultsA total of 283 patients participated in this study; 247 patients, 121 patients in the placebo group and 126 in the imiquimod group, accounted for the modified ITT population. The first extralesional extirpation was performed in 116 (92%) imiquimod patients and in 102 (84%) placebo patients; the difference was not significant (p = 0.0743). Regarding the surface of LM, imiquimod reduced the LM surface (4.6–3.1 cm2) significantly (p < 0.001) more compared to the placebo (3.9–4.1 cm2).ConclusionImiquimod reduces the lentigo maligna surface after 1 month of treatment, without a higher risk of intralesional excision and with a positive aesthetic outcome.

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Comparison of Melanocyte Density Counts in Topical Imiquimod-Treated Skin Surrounding Lentigo Maligna vs Control Biopsy Specimens

Abstract: We thank Johanna McArdle, BA, and Liset Chacin, BS, both at Brigham and Women's Hospital, for their help in the coordination of the scribe surveys. They were not compensated.

Cited by 11 publications

References 6 publications

Is melanocyte density our last hope? Comparison of histologic features of photodamaged skin and melanoma in situ after staged surgical excision with concurrent scouting biopsies

Is melanocyte density our last hope? Comparison of histologic features of photodamaged skin and melanoma in situ after staged surgical excision with concurrent scouting biopsies

Melanocyte Density in the Diagnosis of Melanoma In Situ in Sun-Damaged Skin

Efficacy of imiquimod in the management of lentigo maligna

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