scholarly journals Incompletely excised lentigo maligna melanoma is associated with unpredictable residual disease: clinical features and the emerging role of reflectance confocal microscopy

2020 ◽  
Vol 34 (10) ◽  
pp. 2280-2287 ◽  
Author(s):  
C. Navarrete‐Dechent ◽  
S. Aleissa ◽  
M. Cordova ◽  
K. Liopyris ◽  
E.H. Lee ◽  
...  
Keyword(s):  
Confocal Microscopy ◽  
Clinical Features ◽  
Residual Disease ◽  
Reflectance Confocal Microscopy ◽  
Lentigo Maligna ◽  
Lentigo Maligna Melanoma

scholarly journals Evaluating the Diagnostic Accuracy of Reflectance Confocal Microscopy to Diagnose Skin Cancer: A Research Protocol (Preprint)

2017 ◽  
Author(s):  
Naomi D Herz ◽  
Anastasia Chalkidou ◽  
Fiona Reid ◽  
Stephen Keevil ◽  
Andrew Coleman ◽  
...  
Keyword(s):  
Skin Cancer ◽  
Confocal Microscopy ◽  
Surgical Excision ◽  
Reflectance Confocal Microscopy ◽  
Lentigo Maligna ◽  
Recurrence Rates ◽  
Skin Cancer Screening ◽  
Lentigo Maligna Melanoma ◽  
Excision Margins ◽  
The Uk

UNSTRUCTURED Skin cancer is the most common type of cancer in the UK, with over 100,000 cases diagnosed each year. Melanoma is a type of skin cancer that can develop from a mole. However, moles that are suspicious histologically are often difficult to diagnose clinically by eye, even for experts working in specialist skin cancer screening clinics. In the UK, 350,000 patients per year are referred to hospital clinics with suspicious moles, and approximately half undergo a biopsy to identify the 5-10% who require further treatment. If cancer cannot be ruled out clinically and on the basis of biopsy results, the lesion is surgically removed. One type of pre-cancerous mole, called lentigo maligna, is particularly challenging to treat. It develops insidiously, can become large, and is difficult to assess when it transforms into a lentigo maligna melanoma. It is also difficult to identify the margins by eye or with the aid of a dermatoscope. This results in high excision rates. Excision is often incomplete despite large areas of tissue removal (5 mm around tumour’s visible margin), and there are high recurrence rates even when the lesion is considered successfully removed. Reflectance confocal microscopy is an imaging technique that can supplement dermoscopy in identifying if a clinically suspicious mole is malignant and can better assess lentigo maligna margins. It allows clinicians to see the skin lesion in greater detail than dermoscopy and therefore better guide more accurate diagnoses. This prospective study will examine patients with suspicious moles and lentigo maligna to determine whether confocal microscopy can both reduce the number of unnecessary biopsies of moles and more accurately guide the surgical excision margins of lentigo maligna.

scholarly journals Langerhans Cells as Morphologic Mimickers of Atypical Melanocytes on Reflectance Confocal Microscopy: A Case Report and Review of the Literature

2021 ◽  
pp. 2021078
Author(s):  
Nadiya Chuchvara ◽  
Lauren Berger ◽  
Catherine Reilly ◽  
Amin Maghari ◽  
Babar Rao
Keyword(s):  
Dendritic Cells ◽  
Confocal Microscopy ◽  
Langerhans Cells ◽  
Melanocytic Nevus ◽  
Reflectance Confocal Microscopy ◽  
Lentigo Maligna ◽  
Lentigo Maligna Melanoma ◽  
Atypical Cells ◽  
Neoplastic Process ◽  
Solar Lentigo

Pagetoid spread of melanocytes in the epidermis is a common indicator of melanocytic atypia, both histopathologically and with reflectance confocal microscopy (RCM). Specifically on RCM, large, bright, atypical dendritic and/or roundish cells are characteristic of melanoma. However, intraepidermal Langerhans cells (ILC) create the potential for diagnostic ambiguity on RCM. We describe one case of a pigmented facial lesion that was initially diagnosed as lentigo maligna (LM) due to numerous atypical perifollicular dendritic cells on RCM. Additionally, we present the findings of a literature review for similar reported cases conducted by searching the following terms on PubMed: reflectance confocal microscopy, RCM, lentigo maligna, melanoma, Langerhans cells, dendritic cells, and atypical cells. In our case, the lesion was determined to be a solar lentigo on histopathology. Immunohistochemistry (IHC) with CD1a identified the atypical-appearing cells as ILC, as it did in 54 reported cases of benign lesions (benign melanocytic nevus, Sutton/halo nevus, labial melanotic macule, and solar lentigo) misdiagnosed as malignant on RCM (melanoma, lip melanoma, lentigo maligna, and LM melanoma). According to our case and the literature, both ILC and atypical melanocytes can present with atypical-appearing dendritic and/or roundish cells under RCM. Currently, there is no method to distinguish the two without IHC. Therefore, the presence of pagetoid cells should continue to alert the confocalist of a potential neoplastic process, prompting biopsy, histopathologic diagnosis, and IHC differentiation.    

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