Progression to invasive melanoma frommalignant melanoma in situ, lentigo maligna type

Tannous, Zeina; Lerner, Lisa H.; Duncan, Lyn M.; Mihm, Martín C.; Flotte, Thomas J.

doi:10.1053/hupa.2000.7640

Cited by 75 publications

(42 citation statements)

References 8 publications

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“…It develops mainly in elderly patients. When untreated, LM is associated with a 5-50% risk of progressing to invasive LM melanoma, but the exact determinants for this transformation are still to be elucidated [2,3] . Many therapeutic modalities, including surgery, cryotherapy, radiotherapy and imiquimod cream, have demonstrated an efficacy in the treatment of LM [4] .…”

Section: Introductionmentioning

confidence: 99%

Ingenol Mebutate for Lentigo Maligna: A Case Report

Gadaldi

Feldmeyer²,

Yawalkar³

et al. 2016

Dermatology

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Background: Lentigo maligna (LM) is a melanoma in situ on sun-damaged skin, with a strong predilection to the head and neck area of the elderly. Many therapeutic modalities have been proposed in the treatment of this pathology, including surgery, cryotherapy, radiotherapy and topical imiquimod. Up to date surgical excision remains the treatment of choice with the lowest recurrence rate. Recently, a new topical treatment with ingenol mebutate has been described to be efficacious and well tolerated in the treatment of melanoma in situ. Objective: We sought to demonstrate that ingenol mebutate might be an efficacious and well-tolerated treatment in a patient suffering from LM on an aesthetically challenging location. Methods: Case report. Results: After therapeutic failure with imiquimod 5% cream, a new topical treatment with ingenol mebutate gel 0.015% once daily on 3 consecutive days was initiated. Despite visible inflammation, no macroscopic lesion clearance was observed. While the first follow-up using reflectance confocal microscopy (RCM) performed at 6 weeks after the completion of the therapy showed no signs of LM, the second follow-up examination at 12 weeks using RCM and biopsy confirmed recurrence of the lesion. Conclusion: Ingenol mebutate cannot be considered a standard treatment modality for all types of LM. Further studies are needed to evaluate the prerequisites that can ensure therapeutic success.

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Section: Introductionmentioning

confidence: 99%

Ingenol Mebutate for Lentigo Maligna: A Case Report

Gadaldi

Feldmeyer²,

Yawalkar³

et al. 2016

Dermatology

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“…Although the progression rate of LM into invasive melanoma is below 5% overall [18], it is important to treat LM and prevent progression of disease. In patients with LM, surgical excision is still the gold standard and treatment of choice.…”

Section: Discussionmentioning

confidence: 99%

Confocal Microscopy and Lentigo Maligna: An in vivo Pilot Study for the Assessment of Response to Imiquimod Therapy

Brand

Jafari

Hunger³

2018

Dermatology

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Background: Reflectance confocal microscopy (RCM) is a noninvasive technique that provides real-time in vivo images of the epidermal layer. Imiquimod has been recommended as an alternative treatment in lentigo maligna (LM) when surgical excision is not the treatment of choice. In the present study we compare the results of in vivo RCM to the histopathological examination before and after treatment of LM with topical imiquimod. Methods: Thirty-four patients with confirmed LM were included. Imiquimod 5% was applied until a weeping erosion appeared in the LM-affected skin. Evaluation was performed by clinical examination, dermatoscopy, histopathology and RCM. Results: During the follow-up, 27 of 34 patients (79.42%) demonstrated a total tumor clearance by imiquimod treatment. In the treated area, a significant decrease of atypical cells was detected using RCM (p < 0.0001). Furthermore, a significant positive correlation in the detected atypical cells was shown using confocal microscopy and histology (p = 0.0001, r = 0.7335, respectively). Conclusion: In patients not suitable for surgical intervention imiquimod treatment is an appropriate treatment alternative. Thereby, in vivo RCM was demonstrated to be an excellent examining device, which not only allows diagnosis of LM, but also therapy and follow-up examinations. An important benefit of RCM, in contrast to conventional histopathology, is the simple handling with in vivo examination of epidermal skin without any pain for the patient.

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“…The basic premise of SCM is the selective collection of light from a specific plane in tissue through a pinhole-sized aperture which allows for light collection from the single in-focus plane and the rejection of light from all out-of-focus planes (Nehal et al, 2008). SCM has been recently employed in CMM diagnosis (Gerger et al, 2005;Marghoob & Halpern, 2005), preoperative and intraoperative margin assessment (Busam et al, 2001), and followup for response to medical treatment (Ahmed & Berth-Jones, 2000;Cornejo et al, 2000;Langley et al, 2006;Tannous et al, 2000Tannous et al, , 2002. Commercial SCM instruments have been developed that image with lateral resolution of 0.5 to 1.0 μm and an optical sectioning thickness of 1.0 to 5.0 μm, to a depth of 200 to 300 μm in human skin (depth of papillary dermis).…”

Section: Scanning Confocal Microscopy (Scm)mentioning

confidence: 99%