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Lentigo Maligna

Lentigo, which plural is Lentigenes, is a common benign condition characterized by areas of melanocyte proliferation, and the hyperpigmentation of the epidermal basal cell layer in a linear fashion with resulting lesions shaped as 5-10 mm oval nodules, with a tan-brown color. It is an acquired lesion that is usually related to sun exposure in youth but unlike freckles, lentigo lesions do not darken in response to sunlight exposure. Although benign, it may progress towards malignant change under certain circumstances or as systemic response. In general terms, these nodules occur in all age groups and they are found equally amongst the different races and sexes.

Lentigo Picture

Lentigines are observed worldwide and the incidence depends on the type of lesion. In the United States solar lentigines are observed in 90 percent of Caucasian population older than 60 years and in 20 percent of Caucasian younger than 35 years. The most common form found is lentigo benigna or simplex, but it has not to be determined. Solar lentigines are more frequency observed in fair-skinned whites than in dark-skinned individuals, because they have a greater amount of natural pigment that provides some degree of photo-protection. Some inherited patterned lentiginosis can occur in blacks, particularly those with mixed American Indian heritage and those with relatives with red hair as well as Ink-spot lentigo that occur in patients of Celtic ancestry.

Lentigo Picture

Lentigines are more common in men than in women and the patches can appear in both children and adults, whom are more likely to acquire these lesions due to chronic sun exposures, that however, children to whom lentigo is genetically associated with lesions such as those of Peutz-Jeghers syndrome. According to lesions, if the melanocytes have a normal cytological appearance the condition is known as lentigo simplex or benigna, but if the melanocytes have abnormal cytology, then such condition is known as lentigo maligna. When the melanocytes proliferate through the basal lamina then the condition becomes a malignant melanoma.

Lentigo Picture

As Lentigo maligna is characterized by a brown patch, generally on the face of the elderly people, it may lead to lentigo maligna melanoma, a spreading brown patch, often with considerable variation in color ranging from brown to black and with pigmentation that may be homogeneous or variegated. It is absolutely flat but the patch may expand slowly over years until a nodule is developed within it resulting in lentigo maligna melanoma. Sometimes the nodule may be eruptive and appear rather suddenly at any age. Some lentigines are associated with systemic abnormalities in addition to any of their dermatologic manifestations.

Lentigo maligna is also known as Hutchinson’s freckle, and only appears on sun-exposed areas of the skin and it is one of the 4 major types of melanoma and the one that has the most favorable prognosis because there is less risk of it spreading to other areas of the body. Depending on the type of lentigo present, the dermatological manifestation may be a solitary lesion or multiple lesions that can occur anywhere on the body. Both, lentigo maligna and lentigo maligna melanoma, occur most often in areas of maximal sun exposure on the face and, unlike lentigo benigna and other types of melanoma that usually tend to predominate in areas of intermittent severe sun exposure. In lentigo maligna the distribution of lesions on the face are parallel that those of actinic keratoses, and squamous carcinoma.

However due the risk of skin cancer, it is important to acquire the correct diagnose since multiple clinical and etiologic varieties exist. The distinction of lentigo from other melanocytic lesions and its role as a marker for ultraviolet damage and systemic syndromes is of major significance. Lentigo maligna can be confused with lentigo benigna or simplex because elderly people commonly develop brown patches on the face secondary to actinic damage and only in a few cases they are lentigo maligna. Some lentigines have associated systemic disorders along with the skin lesions. Lentigenes frequently may be diagnosed through an incisional shave biopsy, submitted to a qualified dermatopathologist alongside with the corresponding clinical history to establish whether the brown patch is benign or pre-malignant.

For most of the lentigo maligna cases, the treatment of choice is surgical excision if the lesion is small. Retinoids decrease the cohesiveness of abnormal hyper-proliferative keratinocytes and may reduce the potential for malignant degeneration and consequently reduce the risk of skin cancer in patients who have undergone renal transplantation. Radiation therapy is the treatment of choice for elderly patients with an extensive lesion. These lesions should not be treated with liquid nitrogen cryotherapy, as a rule, because the dysplastic melanocytes go down hair follicles and deep recurrence post-cryotherapy is common.

Prevention should be focused to reduce morbidity and prevent complications. It is always advisable to use an application of sunscreen to help decrease the rate of appearance and the darkening of solar lentigines. Limiting the sun exposure and the avoidance of sun tanning, the same as the use of artificial sources of UV light such as tanning beds, may help to prevent this condition.

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