So is the Lentigo Maligna
Lentigo maligna represents a form of skin cancer (melanoma), which occurs mainly in the face of elderly people, appearing as a pigmented spot.
More precisely, lentigo maligna is a form of skin cancer considered to be the precursor of lentigo maligna melanoma, otherwise known as lentigo maligna type melanoma.
The latter, among the four subtypes of invasive malanoma (superficial, nodular, lentiginous actral and lentigo malignant melanoma) occurs in 5-15% of cases.
To be fair, some authors do not consider lentigo maligna a real form of cancer, but consider it as a pre-malignant skin lesion.
Lentigo maligna is also known as "Hutchinson's melanotic spot" or "Hutchinson's ephelis". These names derive from John Hutchinson, who for the first time, in 1890, described the disease.
Causes
What are the Causes and Risk Factors of Lentigo Maligna?
The exact causes underlying the formation of lentigo maligna have not yet been fully identified. On the other hand, it is believed that - as in the majority of tumors - the etiology of the pathology may be multifactorial.
In this regard, we remind you that the possible predisposing risk factors for the formation of lentigo maligna seem to be:
- Cellular damage caused by excessive and uncontrolled exposure to UV rays;
- The genetic predisposition;
- The presence of any pigmented nevi;
- The presence of other skin diseases, such as, for example, seborrheic keratosis, pigmented actinic keratosis and basal cell carcinoma.
Incidence
If until a few years ago lentigo maligna was an infrequent condition, in recent years there has been an increase in its incidence in subjects of a certain age.
In fact, this pathology occurs mostly in elderly people whose skin has suffered various damage from the sun and UV rays.
Lentigo maligna can occur in patients of both sexes.
Affected areas
Lentigo maligna mostly affects the areas most affected by solar radiation; not surprisingly - as previously mentioned - lentigo maligna is influenced by factors such as solar lentigo, pigmented or seborrheic actinic keratosis and basal cell carcinoma.
In any case, lentigo maligna occurs mostly at the level of the face (in particular, on the cheeks and forehead) and - depending on the area of the face where it occurs - it can even affect the oral mucosa or the eyelids.
Features
Lentigo maligna differs from other forms of benign spots by the presence of atypical and unusual signs in the skin lesions.
In fact, melanocytes - the cells responsible for skin pigmentation - have disproportionate shapes and tend to penetrate deep into the epidermal layers.
See More Photos Lentigo Maligna
Lentigo maligna generally occurs in the form of brownish-brown spots, lined with darker, sometimes black, dots that spread unevenly on the skin.
In other cases, however, the lesions may even be red or white and their pigmentation becomes more and more irregular with the passage of time. In any case, the margins of these spots are always irregular.
Lentigo maligna represents a subtle and deceptive condition: at first it affects the face, which has small hyperpigmented patches. Over the years, the spots evolve and progress, extending to a considerable size (the patches can exceed six centimeters in diameter): this condition can further aggravate, become invasive, develop deeply and give rise to lentigo-like melanoma malignant which, in turn, can give rise to metastases.
Generally, the development of nodules - associated or not with bleeding - is a clear indication of the invasion and the successful transition to the form of melanoma.
It is not yet clear why the growth of the malignant spot takes so long: if the development of the lentigo is horizontal, the chances of a perfect prognosis following surgical removal are very high. On the other hand, if the extension of the spot tends to a vertical growth, the prognosis is almost identical to all the sub-species of melanoma.
Macula of light brown color with precise, well delimited borders
Evolution and Complications
As mentioned, lentigo maligna can grow very slowly, going deep, until it becomes complicated and evolves to the condition of real melanoma.
Lentigo maligna melanoma can also metastasize and spread via the blood or lymphatic pathway. The metastasis, in turn, can be limited or affect all areas of the organism (skin, internal organs, mucous membranes: melanoma affecting the mucous membranes has the worst prognosis).
If lentigo maligna melanoma is localized to a specific area, local metastasis could result in the formation of papules, nodules and, occasionally, lymph nodes.
After 70-75 years of age, the risk of lentigo maligna evolving into melanoma of the lentigo maligna type has been estimated at 1-2%.
Diagnosis
Unfortunately, the diagnosis of lentigo maligna is very complicated, especially during the initial period in which it appears on the skin of patients. In fact, the skin lesions of lentigo maligna can be confused with other diseases or disorders that affect sun-damaged skin, such as keratosis, senile lentigo, hyperpigmented lesions of various types, etc.
Therefore, simple "naked eye" analysis cannot be helpful. Indeed, often, even dermatoscopy does not allow a certain diagnosis to be made.
To complicate everything, is added the evolution of this pathology, slow and subtle, which certainly does not help the doctor to make a timely diagnosis.
However, an uncertain diagnosis could be confirmed by performing a biopsy.
Treatments
Based on the condition of the affected subject, the extent of the lentigo malignant and the rate of extension of the same, the doctor will determine which therapy is most suitable for the patient. Generally, the following preferential therapies are the following.
Pharmacological treatments
Lentigo maligna can be treated by resorting to the use of anticancer drugs (such as, for example, temozolomide), immunomodulatory drugs (such as, for example, Imiquimod) or immunostimulating drugs (such as, for example, interleukin-2) .
In any case, for more information on this, we recommend reading the "dedicated article" Lentigo Maligna - Drugs for the Treatment of Lentigo Maligna ".
Radiotherapy
With radiotherapy, the destruction of the tumor can be achieved through the use of ionizing radiation. The radiations are directed on the diseased skin: cancer cells are the target and their DNA is destroyed.
Cryotherapy
Cryotherapy (cold therapy) is a technique based on the "use of" liquid nitrogen (which reaches very low temperatures, equal to 196 ° C below zero). Nitrogen, in contact with the skin, causes a burn of the tissue: the cells undergo a thermal shock with immediate lysis of the lentigo maligna.
Curettage
The term curettage derives from "curette ", the instrument used in surgery to remove the injured part. The technique is not very painful and is generally used to remove papules; in some cases, the affected part is anesthetized to reassure the patient. Curettage is also used in the treatment of seborrheic keratosis.
Surgical excision
Surgical removal is the most widely used technique to eliminate lentigo maligna and lentigo maligna melanoma. The tumor spot is surgically removed: a skin graft is also possible.
Following resolutive treatments, it is necessary for the patient to undergo periodic checks: in this way, the chances of the melanoma lentigo maligna reappear and create further damage are reduced.
Lentigo Maligna - Medicines for the treatment of Lentigo Maligna "
