WordNet
- evil or harmful in nature or influence; "prompted by malign motives"; "believed in witches and malign spirits"; "gave him a malign look"; "a malign lesion"
- any of several malignant neoplasms (usually of the skin) consisting of melanocytes (同)malignant_melanoma
PrepTutorEJDIC
- 《名詞の前にのみ用いて》(物事が)悪影響のある,有害な(injurious) / (人が)悪意のある(malicious);(…に)悪意のある《+『to』(『toward』)+『名』》 / …‘を'中傷する,けなす(slander)
Wikipedia preview
出典(authority):フリー百科事典『ウィキペディア(Wikipedia)』「2015/06/15 23:38:18」(JST)
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Lentigo maligna melanoma |
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Classification and external resources |
ICD-10 |
C43 (ILDS C43.L40) |
ICD-O |
M8742/3 |
DiseasesDB |
32059 |
eMedicine |
med/1278 |
MeSH |
D018327 |
Lentigo maligna melanoma is a melanoma that has evolved from a lentigo maligna.[1]:695 They are usually found on chronically sun damaged skin such as the face and the forearms of the elderly. The nomenclature is very confusing to both patients and physicians alike.
Lentigo maligna is the non-invasive skin growth that some pathologists consider to be a melanoma-in-situ.[2] A few pathologists do not consider lentigo maligna to be a melanoma at all, but a precursor to melanomas. Once a lentigo maligna becomes a lentigo maligna melanoma, it is treated as if it were an invasive melanoma.
Contents
- 1 Presentation
- 2 Diagnosis
- 3 Treatment
- 4 See also
- 5 References
Presentation
An invasive tumor arising from a classical lentigo maligna. Usually a darkly pigmented raised papule or nodule, arising from a patch of irregularly pigmented flat brown to dark brown lesion of sun exposed skin of the face or arms in an elderly patient.
Diagnosis
First dilemma in diagnosis is recognition. As lentigo malignas often present on severely sun damaged skin, it is frequently found amongst numerous pigmented lesions - thin seborrheic keratoses, lentigo senilis, lentigines. It is difficult to distinguish these lesions with the naked eye alone, and even with some difficulty using dermatoscopy. As the lentigo maligna is often very large, it often merges with, or encompasses other skin tumors - such as lentigines, melanocytic nevi, and seborrheic keratosis.
Second dilemma is the biopsy technique. Even though excisional biopsy (removing the entire lesion) is ideal, and advocated by pathologists, practical reason dictates that this should not be done. These tumors are often large and presenting on the facial area. Excision of such large tumor would be absolutely contradicated if the lesion's identity is uncertain. The preferred method of diagnosis is by using a shave biopsy because punch biopsies give up to an 80% false negative rate. While one section of the tumor might show benign melanocytic nevus, another section might show features concerning of severe cellular atypia. When cellular atypia is noted, a pathologist might indicate that the entire lesion should be removed. It is at this point that one can comfortably remove the entire lesion, thus confirming the final diagnosis of lentigo maligna. Despite the high false negative rate, punch biopsies are often used and the size of the punch biopsy can vary from 1 mm to 2 mm, but it is preferred to use a punch 1.5 mm or larger. Representative samples of the most atypical part of the nevus should be biopsy, often by the aid of dermatoscopy.
Treatment
Treatment depends on the thickness of the invasive component of the lentigo maligna. Treatment is essentially identical to other melanomas of the same thickness and stage.
See also
References
- ^ James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0.
- ^ McKenna JK, Florell SR, Goldman GD, Bowen GM (April 2006). "Lentigo maligna/lentigo maligna melanoma: current state of diagnosis and treatment". Dermatol Surg 32 (4): 493–504. doi:10.1111/j.1524-4725.2006.32102.x. PMID 16681656.
Tumors: Skin neoplasm, Nevi and melanomas (C43/D22, 172/216, ICD-O 8720-8799)
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Melanoma |
- Mucosal melanoma
- Superficial spreading melanoma
- Nodular melanoma
- lentigo
- Lentigo maligna/Lentigo maligna melanoma
- Acral lentiginous melanoma
- Amelanotic melanoma
- Desmoplastic melanoma
- Melanoma with features of a Spitz nevus
- Melanoma with small nevus-like cells
- Polypoid melanoma
- Nevoid melanoma
- Melanocytic tumors of uncertain malignant potential
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Nevus/
melanocytic nevus |
- Nevus of Ito/Nevus of Ota
- Compound nevus
- Spitz nevus
- Pigmented spindle cell nevus
- Halo nevus
- Junctional nevus
- Pseudomelanoma
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- Blue nevus
- of Jadassohn–Tièche
- Cellular
- Epithelioid
- Deep penetrating
- Amelanotic
- Malignant
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- Congenital melanocytic nevus (Giant
- Medium-sized
- Small-sized)
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- Balloon cell nevus
- Dysplastic nevus/Dysplastic nevus syndrome
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- Acral nevus
- Becker's nevus
- Benign melanocytic nevus
- Nevus spilus
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Index of skin
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Description |
- Anatomy
- Physiology
- Development
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Disease |
- Infections
- Vesiculobullous
- Dermatitis and eczema
- Papulosquamous
- Urticaria and erythema
- Radiation-related
- Pigmentation
- Mucinoses
- Keratosis, ulcer, atrophy, and necrobiosis
- Vasculitis
- Fat
- Neutrophilic and eosinophilic
- Congenital
- Neoplasms and cancer
- nevi and melanomas
- epidermis
- dermis
- Symptoms and signs
- Terminology
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Treatment |
- Procedures
- Drugs
- antibiotics
- disinfectants
- emollients and protectives
- itch
- psoriasis
- other
- Wound and ulcer
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UpToDate Contents
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English Journal
- Intraoperative Real-Time Reflectance Confocal Microscopy for Guiding Surgical Margins of Lentigo Maligna Melanoma.
- Hibler BP1, Cordova M, Wong RJ, Rossi AM.
- Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].Dermatol Surg.2015 Jun 2. [Epub ahead of print]
- PMID 26050216
- Clinical and dermoscopic characteristics of melanomas on nonfacial chronically sun-damaged skin.
- Jaimes N1, Marghoob AA2, Rabinovitz H3, Braun RP4, Cameron A5, Rosendahl C5, Canning G6, Keir J7.
- Journal of the American Academy of Dermatology.J Am Acad Dermatol.2015 Jun;72(6):1027-35. doi: 10.1016/j.jaad.2015.02.1117. Epub 2015 Mar 29.
- BACKGROUND: Melanomas on chronically sun-damaged skin (CSDS) can be difficult to identify and often manifest morphologic features that overlap with benign lesions.OBJECTIVE: We describe and analyze the clinical and dermoscopic characteristics of melanomas on nonfacial CSDS.METHODS: Melanoma cases on
- PMID 25824275
- Imiquimod 5% cream as primary or adjuvant therapy for melanoma in situ, lentigo maligna type.
- Swetter SM1, Chen FW2, Kim DD2, Egbert BM3.
- Journal of the American Academy of Dermatology.J Am Acad Dermatol.2015 Jun;72(6):1047-53. doi: 10.1016/j.jaad.2015.02.008. Epub 2015 Mar 17.
- BACKGROUND: Surgical resection of lentigo maligna (LM) is complicated by noncontiguous, subclinical extension and actinic melanocytic hyperplasia in sun-damaged skin of older individuals.OBJECTIVE: We sought to determine the long-term effectiveness of imiquimod as primary or adjuvant therapy for LM.
- PMID 25791801
Japanese Journal
- 自治医科大学附属病院皮膚科における悪性黒色腫121例(1998〜2008年)の統計的検討
- 村田 哲,横倉 英人,増田 智一,藤田 悦子,池田 雄一,小池 裕美子,田口 佳代子,若旅 功二,遠田 博,細田 里美,高塚 由佳,立田 彩,佐藤 篤子,大山 正彦,藤本 美津夫,清澤 智晴,山田 朋子,小宮根 真弓,中川 秀己,大槻 マミ太郎
- 自治医科大学紀要 32, 43-49, 2010-03-01
- 1998年から2008年まで, 自治医科大学附属病院皮膚科で経験した121例の悪性黒色腫について統計的に検討した。男性54例,女性67例で,それぞれ年齢分布のピークは60歳代と70歳代にあった。増加傾向にあるが,特に早期病変の症例の増加が著しかった。病型別では末端黒子型が44.6%,悪性黒子型が10.7%,表在拡大型が20.7%,結節型が19.8%であった。5年生存率はstage0が100.0%, …
- NAID 110007726758
- IS-35 Primary vulvar lentigo maligna, a subtype of melanoma in situ in an Asian woman, a case report(Group5 Oncology5,International Session)
- Wang Chiao-Hui,Lin Pin-Yao,Lin Hao,Jeng Sheng-Feng
- 日本産科婦人科學會雜誌 62(2), 785, 2010-02-01
- NAID 110007686777
Related Links
- Photograph shows lentigo maligna melanoma on a patient’s cheek. Lentigo maligna melanoma most commonly occurs on sun-exposed skin, especially of the face, in elderly persons. It is characterized by a highly ...
- What is the outlook for patients with melanoma? Lentigo maligna is not dangerous; it only becomes potentially life threatening if an invasive melanoma develops within it. Long term follow-up involves reviewing the treated area and full ...
Related Pictures
![Lentigo maligna](https://1mg.info/0/2/y/2786.jpg)
![lentigo maligna melanoma](https://1mg.info/0/2/y/2787.jpg)
![lentigo maligna melanoma.jpg](https://1mg.info/0/2/y/2788.jpg)
![lentigo maligna](https://1mg.info/0/2/y/2789.jpg)
![LENTIGO MALIGNA (MELANOSIS PRAECANCEROSA](https://1mg.info/0/2/y/2790.jpg)
★リンクテーブル★
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- 英
- malignant melanoma MM
- 同
- メラノーマ melanoma
- ラ
- melanoma malignum
- 関
- メラニン尿
概念
悪性黒色腫のABCDE NDE.421
頭文字
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特徴
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A
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Asymmetry
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不規則形
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B
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Borderline irregularity
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境界不鮮明
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C
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Color variegation
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色調多彩
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D
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Diameter enlargement
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拡大傾向(直径6mm以上)
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E
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Elevation of surface
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表面隆起
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疫学
- 人口10万対:白人10~20、日本人1~2、黒人1以下
- 白人では体幹や四肢に好発し,表在拡大型が大多数を占める。日本人では足底や爪部(爪下黒色腫subungual melanoma)など四肢末端部に好発し,末端黒子型が多い
病変形成&病理
発生母地
臨床像による分類
- 悪性黒子から移行する。
- 高齢者の顔面に好発。
- 他の3型に比べて予後が良好。
- 四肢末端(特に足底)、爪、粘膜に生じ、日本人に多い。
- 褐色ないし黒色の斑として生じ、浸潤性に増殖すると結節をつくる。
- Hutchinson徴候-爪では縦に黒色線状を呈し、爪溝を越えて色素斑が拡大する。
- はじめ水平方向に扁平隆起性に拡大し、やがて垂直方向に浸潤増殖する。
- 褐色ないし、黒色の斑点として生じる。
- 垂直方向に浸潤増殖して結節を形成し、水平方向には展開しない。
- 予後が悪い。
- 色素を欠き、白くなるものもある。
ダーモスコピー所見
- 皮丘有意な色素沈着。感度86%, 特異度99% → 皮丘優位ではないことを検討してメラノーマを除外しよう! Nikkei Medical 2005 pp.116
- メラノーマでは86%に皮丘優位の色素沈着あり
- メラノーマでないとき、99%が皮丘優位ではない
治療
- modality:(第一選択)外科治療、放射線療法、化学療法、免疫療法
ガイドライン
- 1. Clinical Question - 悪性黒色腫 - 日本皮膚科学会
- http://www.dermatol.or.jp/medical/guideline/skincancer/cq.html#mm
- 2. アルゴリズム - 悪性黒色腫 - 日本皮膚科学会
- http://www.dermatol.or.jp/medical/guideline/skincancer/mm/mm.html
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