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)

wiki en

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.

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.

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.

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 悪性黒子：臨床症状、診断、およびマネージメント lentigo maligna clinical manifestations diagnosis and management
2. 黒色腫の病理学的特徴 pathologic characteristics of melanoma
3. Clinical features and diagnosis of cutaneous melanoma
4. 顔面病変のダーモスコピー dermoscopy of facial lesions
5. 黒色腫（メラノーマ）のマネージメントにおける放射線療法 radiation therapy in the management of melanoma

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 Pictures

★リンクテーブル★

リンク元	「悪性黒色腫」
関連記事	「malign」

「悪性黒色腫」

Lentigo maligna melanoma
Classification and external resources
ICD-10	C43 (ILDS C43.L40)
ICD-O	M8742/3
DiseasesDB	32059
eMedicine	med/1278
MeSH	D018327

　　[★]

英: malignant melanoma MM
同: メラノーマ melanoma
ラ: melanoma malignum
関: メラニン尿

概念

メラノサイト(神経堤由来)が癌化した悪性腫瘍
色調は多くが黒褐色。紅色調病変もありうる(無色素性黒色腫 amelanotic melanoma)　←　メラニン合成能の喪失
転移能しやすい。予後不良。　→　リンパ行性が最も頻度が高い・・・だっけ？
原発：皮膚。粘膜(口腔、鼻腔)、脈絡膜、脳軟膜、眼もありうる。