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    Lentigo Maligna Busam

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    sviatoha
    This document discusses pathology related to lentigo maligna, a type of melanoma in situ. It begins with terminology used for lentigo maligna and notes that histopathology can sometimes be subtle or ambiguous. Examples of lentigo maligna pathology shown include multinucleated giant cells, lichenoid inflammation, and junctional nests. Differential diagnoses discussed include distinguishing melanoma in situ from other pigmented lesions and identifying dermal invasion. Tricky scenarios like lentigo maligna colliding with keratosis or a junctional nevus are also covered. The document concludes with notes on processing excisions for margin assessment and initial management of lentigo maligna with shave excision.

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    Lentigo Maligna Busam

    Uploaded by

    sviatoha
    21 views20 pages
    This document discusses pathology related to lentigo maligna, a type of melanoma in situ. It begins with terminology used for lentigo maligna and notes that histopathology can sometimes be subtle or ambiguous. Examples of lentigo maligna pathology shown include multinucleated giant cells, lichenoid inflammation, and junctional nests. Differential diagnoses discussed include distinguishing melanoma in situ from other pigmented lesions and identifying dermal invasion. Tricky scenarios like lentigo maligna colliding with keratosis or a junctional nevus are also covered. The document concludes with notes on processing excisions for margin assessment and initial management of lentigo maligna with shave excision.

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    Lentigo_Maligna_Busam

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    This document discusses pathology related to lentigo maligna, a type of melanoma in situ. It begins with terminology used for lentigo maligna and notes that histopathology can sometimes be subtle or ambiguous. Examples of lentigo maligna pathology shown include multinucleated giant cells, lichenoid inflammation, and junctional nests. Differential diagnoses discussed include distinguishing melanoma in situ from other pigmented lesions and identifying dermal invasion. Tricky scenarios like lentigo maligna colliding with keratosis or a junctional nevus are also covered. The document concludes with notes on processing excisions for margin assessment and initial management of lentigo maligna with shave excision.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    21 views20 pages

    Lentigo Maligna Busam

    Uploaded by

    sviatoha
    This document discusses pathology related to lentigo maligna, a type of melanoma in situ. It begins with terminology used for lentigo maligna and notes that histopathology can sometimes be subtle or ambiguous. Examples of lentigo maligna pathology shown include multinucleated giant cells, lichenoid inflammation, and junctional nests. Differential diagnoses discussed include distinguishing melanoma in situ from other pigmented lesions and identifying dermal invasion. Tricky scenarios like lentigo maligna colliding with keratosis or a junctional nevus are also covered. The document concludes with notes on processing excisions for margin assessment and initial management of lentigo maligna with shave excision.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 20

    Memorial Sloan-Kettering

    Cancer Center, New York City


    KJ Busam, M.D.; Dept of Pathology

    Pathology of Lentigo Maligna


    Normal sun-damaged skin

    Lentigo maligna
    Terminology – Lentigo Maligna
    • Lentigo Maligna Melanoma in situ

    • Lentigo Maligna
    – Histopathologically pauci-cellular or subtle
    – “Early evolving lesion”

    • “Atypical intraepidermal melanocytic proliferation”


    – Ambiguous histopathology; biopsy too small
    Lentigo maligna with junctional nests
    Lentigo Maligna

    Multinucleated “star burst” giant cells; lichenoid inflammatory reaction


    Differential Diagnosis

    • EPIDERMIS: Melanoma in situ vs benign


    – Solar melanocyte hyperplasia
    – Solar lentigo, pigm SK, LPLK, pigm AK
    – Junctional melanocytic nevus

    • DERMIS: Invasion or not?


    – Scar vs invasive desmoplastic melanoma
    – Invasive melanoma vs incidental melanocytic nevus
    – Invasion vs adnexal involvement by MIS
    LM vs Keratosis - Pitfalls
    • Melanocyte hyperplasia vs neoplasm

    • Collision scenario
    – LM colliding with keratosis
    – Melanocytic nevus colliding with keratosis

    • Epidermal and/or inflammatory changes


    simulating a keratosis
    Junctional Melanocytic Nevus
    Junctional Nevus of MIS?
    Melanoma in Situ
    MIS vs Junctional Nevus
    • A new melanocytic proliferation of sun-
    damaged skin with features of a junctional
    “dysplastic nevus” is likely MIS

    • Not all junctional melanocytic proliferations of


    sun-damaged skin are MIS
    Diff. Diagnosis – Invasion or Not?

    • Adnexal involvement vs dermal invasion


    • Incidental nevus vs invasion
    • Microinvasion
    • Scar vs desmoplastic melanoma
    LMM with Perifollicular Stromal Invasion
    Melanoma simulating a BLK

    Melan-A
    Part II

    Processing of Excisions for


    Margin Assessment
    Margins for LM MIS –
    Often more than 5 mm needed for
    clearance

    J Am Acad Dermatol. 2012;66:438-44.


    Biopsy of MIS with Subsequent
    Invasion in Tumor Debulk
    Percentage of tumors with invasion
    Cohen et al Dermatol Surg 1998 10
    Agarwal-Antal et al JAAD 2002 16
    Zalla et al Dermatol Surg 2000 6.5
    Bub et al Arch Dermatol 2002 5.2
    Iorizzo et al Dermatol Surg 2013 8
    MSKCC (unpublished 2016) 6
    Management of Lentigo Maligna

    Initial Shave Excision for Dx and prelimin margin assessment


    THANK YOU!

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