Neck Melanoma: Clinical, Dermoscopic and Confocal Features

Dermatology ◽  
2019 ◽  
Vol 236 (3) ◽  
pp. 241-247
Author(s):  
Stefania Borsari ◽  
Riccardo Pampena ◽  
Margherita Raucci ◽  
Marica Mirra ◽  
Simonetta Piana ◽  
...  
Keyword(s):  
Confocal Microscopy ◽  
Head And Neck ◽  
Skin Lesions ◽  
Lentigo Maligna ◽  
Diagnostic Features ◽  
Neck Area ◽  
Lentigo Maligna Melanoma ◽  
Melanoma Patients ◽  
Grey Colour ◽  
Rule Out

Background: The head and neck are considered one single anatomical unit. No data on clinical, dermoscopic and confocal aspects of neck melanoma are currently available. Objectives: To identify clinical, dermoscopic and confocal diagnostic features of neck melanomas. Methods: Consecutive malignant (cases) and benign (controls) melanocytic skin lesions located on the neck, excised as suspected of being melanoma from March 2011 to February 2018, were retrospectively retrieved. Dermoscopic criteria of the 7-point checklist, integrated by other melanoma features (such as grey colour and irregular hyperpigmented areas) were assessed. Reflectance confocal microscopy (RCM) images were examined when available. Results: 282 lesions located to the head and neck area were biopsied to rule out melanoma. Thirty-one out of 282 (11%) lesions were located on the neck: 21 melanomas and 10 naevi. Melanoma patients were older than patients with naevi (mean age: 60.4 vs. 37.9 years, p < 0.001). Neck melanomas were more frequently located on sun-damaged skin compared to naevi (76.2 vs. 30%, p = 0.02). Dermoscopically, neck melanomas were characterized by irregular dots/globules, grey colour and regression (76.2, 81 and 46.7% of cases) and showed criteria of lentigo maligna melanoma (LMM) in 52.4% of cases. Regression, grey colour, irregular hyperpigmented areas and criteria of LMM typified melanomas on sun-damaged skin, whereas tumours located on non-sun-damaged areas were often characterized by irregular pigmentation (blotches). RCM, implemented to dermoscopy, correctly diagnosed 10/12 melanomas and 3/5 naevi. Conclusion: Neck melanoma has peculiar clinical and dermoscopic aspects that could help clinicians to distinguish it from naevi and to diagnose melanoma earlier.

scholarly journals Lentigo Maligna Melanoma of the Head and Neck

1993 ◽  
Vol 103 (5) ◽  
pp. 520???524 ◽  
Author(s):  
F. P. Johns Langford ◽  
Samuel R. Fisher ◽  
David W. Molter ◽  
Hilliard F. Seigler
Keyword(s):  
Head And Neck ◽  
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.

Considerations for Timing of Defect Reconstruction in Cutaneous Melanoma of the Head and Neck

2019 ◽  
Vol 35 (04) ◽  
pp. 404-409 ◽  
Author(s):  
Arya W. Namin ◽  
Georgeanne E. Cornell ◽  
Emily H. Smith ◽  
Robert P. Zitsch
Keyword(s):  
Head And Neck ◽  
Local Excision ◽  
Cutaneous Melanoma ◽  
Wide Local Excision ◽  
Tumor Thickness ◽  
Margin Status ◽  
Lentigo Maligna ◽  
Positive Margins ◽  
Lentigo Maligna Melanoma ◽  
Delayed Reconstruction

AbstractThe objective of this study is to identify the incidence and characteristics of cases with positive margins on wide local excision for cutaneous melanoma of the head and neck (CMHN) and therefore provide a potential basis for selectively delaying reconstruction pending final histological clearance of melanoma. A systematic review of English language articles was performed on studies retrieved from PubMed and Web of Science. Original investigations published between July 1999 and June 2018 reporting on margin status of CMHN wide local excision specimens were included in the review. The incidence of positive margins after definitive resection for cutaneous melanoma in the literature ranges from 6 to 20.9%. The incidence is higher in cases of advanced patient age, diagnosis by shave biopsy, lentigo maligna melanoma subtype, desmoplastic subtype, tumor thickness, and ulceration. Delayed reconstruction remains the most oncologically sound decision, allowing for interpretation of margin status on paraffin-embedded tissue sections. However, resection and the resultant defect closure in a single stage is more expedient and potentially a more efficient use of resources. The risk–benefit ratio of immediate versus delayed reconstruction must be considered for each case. The incidence of positive margins is higher in cases of advanced patient age, diagnosis by shave biopsy, lentigo maligna melanoma subtype, desmoplastic subtype, increasing tumor thickness, and the presence of ulceration; delayed reconstruction should be strongly considered in these cases.

Lentigo maligna melanoma has no better prognosis than other types of melanoma.

1984 ◽  
Vol 2 (9) ◽  
pp. 994-1001 ◽  
Author(s):  
H K Koh ◽  
E Michalik ◽  
A J Sober ◽  
R A Lew ◽  
C L Day ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Primary Tumor ◽  
Significant Contribution ◽  
Clinical Stage ◽  
Tumor Thickness ◽  
Lentigo Maligna ◽  
Significant Difference ◽  
Lentigo Maligna Melanoma ◽  
Melanoma Patients

We studied 48 patients with lentigo maligna melanoma (LMM) and compared the clinical stage I patients with non-LMM melanoma patients (matched by site and thickness) to see if prognosis differed. There was no significant difference in mortality from melanoma between the two groups (P = .68) after a mean follow-up time of five years (67.5 months for LMM, 60.5 months for non-LMM). In addition, a Cox multivariate analysis of the entire matched group showed that only thickness was significantly associated with death from melanoma (P = .0007) while histology (LMM v non-LMM) did not make a significant contribution (P = .61). Our data suggest that after accounting for primary tumor thickness and site, LMM and non-LMM have the same prognosis and biologic behavior, in contrast to the widely held belief that LMM has a better prognosis than other forms of melanoma.

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