Skip to main content
SpringerLink
Log in
SpringerLink
Log in

Lentigo Maligna

  • Chapter
European Handbook of Dermatological Treatments

  • 146 Accesses

Abstract

Lentigo maligna is a subtype of in situ melanoma appearing usually in chronically sun-exposed skin (mostly the face) of elderly patients. It manifests clinically as a flat macule with irregular contours and heterogeneous pigmentation. It grows slowly over years but may eventually progress into a vertical growth phase and transform into an invasive melanoma (lentigo maligna melanoma) that has potential for metastasis and lethal outcome; accordingly, this lesion is nowadays regarded more as an authentic in situ melanoma rather than a premalignant condition. There are no prospective, randomised controlled studies evaluating the efficacy of the various treatment modalities applied for the treatment of lentigo maligna. Surgical excision with tumour-free margins is regarded as the best treatment modality, providing the best chances of clearance. Excision can be performed as traditional, one-step tumour ablation with 5–10 mm safety margins or (preferably) with margin-controlled techniques, such as staged excision or Mohs micrographic surgery, the latter two being associated with the lowest recurrence rates. In case of surgically unresectable tumours or in frail patients with severe comorbidities, alternative nonsurgical therapies can be applied, including imiquimod, radiotherapy and cryotherapy/cryosurgery.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 219.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 279.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Further Reading

  • Bassukas ID, Gamvroulia C, Zioga A, Nomikos K, Fotika C. Cryosurgery during topical imiquimod: a successful combination modality for lentigo maligna. Int J Dermatol. ​2008;47:519–21.

    Article  CAS  Google Scholar 

  • Bene NI, Healy C, Coldiron BM. Mohs micrographic surgery is accurate 95.1% of the time for melanoma in situ: a prospective study of 167 cases. Dermatol Surg. 2008;34:660–4.

    CAS  PubMed  Google Scholar 

  • Bichakjian CK, Halpern AC, Johnson TM, Foote Hood A, Grichnik JM, Swetter SM, et al., American Academy of Dermatology. Guidelines of care for the management of primary cutaneous melanoma. J Am Acad Dermatol. 2011;65:1032–47.

    Google Scholar 

  • Böhler-Sommeregger K, Schuller-Petrovic S, Neumann R, Müller E. Cryosurgery of lentigo maligna. Plast Reconstr Surg. 1992;90:436–40.

    Article  Google Scholar 

  • Bosbous M, Dzwierzynski W, Neuburg M. Staged excision of lentigo maligna and lentigo maligna melanoma: a 10-year experience. Plast Reconstr Surg. 2009;124:1947–55.

    Article  CAS  Google Scholar 

  • Bub J, Berg D, Slee A, Odland P. Management of lentigo maligna and lentigo maligna melanoma with staged excision: a 5-year follow-up. Arch Dermatol. 2004;140:552–8.

    Article  Google Scholar 

  • Buettiker UV, Yawalkar NY, Braathen LR, Hunger RE. Imiquimod treatment of lentigo maligna: an open-label study of 34 primary lesions in 32 patients. Arch Dermatol. 2008;144:943–5.

    Article  Google Scholar 

  • Calista D. Treatment of lentigo maligna with topical 1% cidofovir. Br J Dermatol. 2007;157:421–3.

    Article  CAS  Google Scholar 

  • Chapman MS, Spencer SK, Brennick JB. Histologic resolution of melanoma in situ (lentigo maligna) with 5% imiquimod cream. Arch Dermatol. 2003;139:943–4.

    Article  Google Scholar 

  • Collins P, Rogers S, Goggin M, Manning W. Cryotherapy for lentigo maligna. Clin Exp Dermatol. 1991;16:433–5.

    Article  CAS  Google Scholar 

  • Cotter MA, McKenna JK, Bowen GM. Treatment of lentigo maligna with imiquimod before staged excision. Dermatol Surg. 2008;34:147–51.

    Article  CAS  Google Scholar 

  • Craythorne EE, Lawrence CM. Observational study of topical imiquimod immunotherapy in the treatment of difficult lentigo maligna. Clin Med Oncol. 2008;2:551–4.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Dawber RP, Wilkinson JD. Melanotic freckle of Hutchinson: treatment of macular and nodular phases with cryotherapy. Br J Dermatol. 1979;101:47–9.

    Article  CAS  Google Scholar 

  • de Moraes AM, Pavarin LB, Herreros F, De Aguiar Michelman F, Velho PE, de Souza EM. Cryosurgical treatment of lentigo maligna. J Dtsch Dermatol Ges. 2007;5:477–80.

    Article  Google Scholar 

  • de Vries K, Rellum R, Habets JM, Prens EP. A novel two-stage treatment of lentigo maligna using ablative laser therapy followed by imiquimod. Br J Dermatol. 2013;168:1362–4.

    Article  Google Scholar 

  • Demirci H, Shields CL, Bianciotto CG, Shields JA. Topical imiquimod for periocular lentigo maligna. Ophthalmology. 2010;117:2424–9.

    Article  Google Scholar 

  • Ellis LZ, Cohen JL, High W, Stewart L. Melanoma in situ treated successfully using imiquimod after nonclearance with surgery: review of the literature. Dermatol Surg. 2012;38:937–46.

    Article  CAS  Google Scholar 

  • Erickson C, Miller SJ. Treatment options in melanoma in situ: topical and radiation therapy, excision and Mohs surgery. Int J Dermatol. 2010;49:482–91.

    Article  Google Scholar 

  • Farshad A, Burg G, Panizzon R, Dummer R. A retrospective study of 150 patients with lentigo maligna and lentigo maligna melanoma and the efficacy of radiotherapy using Grenz or soft X-rays. Br J Dermatol. 2002;146:1042–6.

    Article  CAS  Google Scholar 

  • Field LM. Cryosurgery for lentigo maligna. J Am Acad Dermatol. 1995;32:686–7.

    Article  CAS  Google Scholar 

  • Fisher GH, Lang PG. Treatment of melanoma in situ on sun-damaged skin with topical 5% imiquimod cream complicated by the development of invasive disease. Arch Dermatol. 2003;139:945–7.

    Article  Google Scholar 

  • Fogarty GB, Hong A, Scolyer RA, Lin E, Haydu L, Guitera P, Thompson J. Radiotherapy for lentigo maligna – a literature review and recommendations for treatment. Br J Dermatol. 2013. doi:10.1111/bjd.12611 (epub ahead of print).

    Article  Google Scholar 

  • Garbe C, Peris K, Hauschild A, Saiag P, Middleton M, Spatz A, et al. Diagnosis and treatment of melanoma. European consensus-based interdisciplinary guideline- update 2012. Eur J Cancer. 2012;48:2375–90.

    Article  Google Scholar 

  • Gaudy-Marqueste C, Perchenet AS, Taséi AM, Madjlessi N, Magalon G, Richard MA, et al. The “spaghetti technique”: an alternative to Mohs surgery or staged surgery for problematic lentiginous melanoma (lentigo maligna and acral lentiginous melanoma). J Am Acad Dermatol. 2011;64:113–8.

    Article  Google Scholar 

  • Guitera P, Moloney FJ, Menzies SW, Stretch JR, Quinn MJ, Hong A, et al. Improving management and patient care in lentigo maligna by mapping with in vivo confocal microscopy. JAMA Dermatol. 2013;149:692–8.

    Article  Google Scholar 

  • Hazan C, Dusza SW, Delgado R, Busam KJ, Halpern AC, Nehal KS. Staged excision for lentigo maligna and lentigo maligna melanoma: a retrospective analysis of 117 cases. J Am Acad Dermatol. 2008;58:142–8.

    Article  Google Scholar 

  • Hedblad MA, Mallbris L. Grenz ray treatment of lentigo maligna and early lentigo maligna melanoma. J Am Acad Dermatol. 2012;67:60–8.

    Article  Google Scholar 

  • Hilari H, Llorca D, Traves V, Villanueva A, Serra-Guillén C, Requena C, et al. Conventional surgery compared with slow Mohs micrographic surgery in the treatment of lentigo maligna: a retrospective study of 62 cases. Actas Dermosifiliogr. 2012;103:614–23.

    Article  CAS  Google Scholar 

  • Hopson B, Richey D, Sajben FP. Treatment of lentigo maligna with imiquimod 5% cream. J Drugs Dermatol. 2007;6:1037–40.

    PubMed  Google Scholar 

  • Hyde MA, Hadley ML, Tristani-Firouzi P, Goldgar D, Bowen GM. A randomized trial of the off-label use of imiquimod, 5%, cream with vs without tazarotene, 0.1%, gel for the treatment of lentigo maligna, followed by conservative staged excisions. Arch Dermatol. 2012;148:592–6.

    Article  CAS  Google Scholar 

  • Junkins-Hopkins JM. Imiquimod use in the treatment of lentigo maligna. J Am Acad Dermatol. 2009;61:865–7.

    Article  Google Scholar 

  • Kallini JR, Jain SK, Khachemoune A. Lentigo maligna: review of salient characteristics and management. Am J Clin Dermatol. 2013;14:473–80.

    Article  Google Scholar 

  • Kamin A, Eigentler TK, Radny P, Bauer J, Weide B, Garbe C. Imiquimod in the treatment of extensive recurrent lentigo maligna. J Am Acad Dermatol. 2005;52(2 Suppl 1):51–2.

    Article  Google Scholar 

  • Kuflik EG, Gage AA. Cryosurgery for lentigo maligna. J Am Acad Dermatol. 1994;31:75–8.

    Article  CAS  Google Scholar 

  • Kunishige JH, Brodland DG, Zitelli JA. Surgical margins for melanoma in situ. J Am Acad Dermatol. 2012;66:438–44.

    Article  Google Scholar 

  • Kupfer-Bessaguet I, Guillet G, Misery L, Carre JL, Leroy JP, Sassolas B. Topical imiquimod treatment of lentigo maligna: clinical and histologic evaluation. J Am Acad Dermatol. 2004;51:635–9.

    Article  CAS  Google Scholar 

  • Lapresta A, García-Almagro D, Sejas AG. Amelanotic lentigo maligna managed with topical imiquimod. J Dermatol. 2012;39:503–5.

    Article  CAS  Google Scholar 

  • Lee H, Sowerby L, Temple C, Yu E, Moore C. Carbon dioxide laser treatment for lentigo maligna: a retrospective review comparing 3 different treatment modalities. Arch Facial Plast Surg. 2011;13:398–403.

    Article  Google Scholar 

  • Litwin MS, Krementz ET, Mansell PW, Reed RJ. Topical chemotherapy of lentigo maligna with 5-fluorouracil. Cancer. 1975;35:721–33.

    Article  CAS  Google Scholar 

  • Ly L, Kelly JW, O’Keefe R, Sutton T, Dowling JP, Swain S, et al. Efficacy of imiquimod cream, 5%, for lentigo maligna after complete excision: a study of 43 patients. Arch Dermatol. 2011;147:1191–5.

    Article  CAS  Google Scholar 

  • Mahoney MH, Joseph MG, Temple C. Topical imiquimod therapy for lentigo maligna. Ann Plast Surg. 2008;61:419–24.

    Article  CAS  Google Scholar 

  • Malhotra R, Chen C, Huilgol S, Hill D, Selva D. Mapped serial excision for periocular lentigo maligna and lentigo maligna melanoma. Ophthalmology. 2003;110:2011–8.

    Article  Google Scholar 

  • Marsden JR, Newton-Bishop JA, Burrows L, Cook M, Corrie PG, Cox NH, et al. Revised U.K. guidelines for the management of cutaneous melanoma 2010. Br J Dermatol. 2010;163:238–56.

    Article  CAS  Google Scholar 

  • Martires KJ, Capaldi L, Pattee SF, Maloney ME, Bordeaux JS. Failed treatment of amelanotic lentigo maligna with imiquimod followed by pigment production. Arch Dermatol. 2010;146:1047–8.

    Article  Google Scholar 

  • McKenna DB, Cooper EJ, Kavanagh GM, Davie RM, McLaren KM, Tidman MJ. Amelanotic malignant melanoma following cryosurgery for atypical lentigo maligna. Clin Exp Dermatol. 2000;25:600–4.

    Article  CAS  Google Scholar 

  • McLeod M, Choudhary S, Giannakakis G, Nouri K. Surgical treatments for lentigo maligna: a review. Dermatol Surg. 2011;37:1210–28.

    Article  CAS  Google Scholar 

  • Muñoz CM, Sánchez JL, Martín-García RF. Successful treatment of persistent melanoma in situ with 5% imiquimod cream. Dermatol Surg. 2004;30(12 Pt 2):1543–5.

    PubMed  Google Scholar 

  • Nadiminti H, Scope A, Marghoob AA, Busam K, Nehal KS. Use of reflectance confocal microscopy to monitor response of lentigo maligna to nonsurgical treatment. Dermatol Surg. 2010;36:177–84.

    Article  CAS  Google Scholar 

  • Narayan R, Nguyen H, Bentow JJ, Moy L, Lee DK, Greger S, et al. Immunomodulation by imiquimod in patients with high-risk primary melanoma. J Invest Dermatol. 2012;132:163–9.

    Article  CAS  Google Scholar 

  • Nazzaro-Porro M, Passi S, Zina G, Breathnach AS. Ten year’s experience of treating lentigo maligna with topical azelaic acid. Acta Derm Venereol. 1989;143:49–57.

    CAS  Google Scholar 

  • O’Neill J, Ayers D, Kenealy J. Periocular lentigo maligna treated with imiquimod. J Dermatolog Treat. 2011;22:109–12.

    Article  Google Scholar 

  • Powell AM, Robson AM, Russell-Jones R, Barlow RJ. Imiquimod and lentigo maligna: a search for prognostic features in a clinicopathological study with long-term follow-up. Br J Dermatol. 2009;160:994–8.

    Article  CAS  Google Scholar 

  • Rajpar SF, Marsden JR. Imiquimod in the treatment of lentigo maligna. Br J Dermatol. 2006;155:653–6.

    Article  CAS  Google Scholar 

  • Raziano R, Clark G, Cherpelis B, Sondak V, Cruse C, Fenske N, et al. Staged margin control techniques for surgical excision of lentigo maligna. G Ital Dermatol Venereol. 2009;144:259–70.

    CAS  PubMed  Google Scholar 

  • Ryan RF, Krementz ET, Litwin MS. A role for topical 5-fluorouracil therapy in melanoma. J Surg Oncol. 1988;38:250–6.

    Article  CAS  Google Scholar 

  • Saiag P, Bosquet L, Guillot B, Verola O, Avril MF, Bailly C, et al., Société Française de Dermatologie. Management of adult patients with cutaneous melanoma without distant metastasis. 2005 update of the French Standards, Options and Recommendations guidelines. Summary report. Eur J Dermatol. 2007;17:325–31.

    Google Scholar 

  • Spenny ML, Walford J, Werchniak AE, Beltrani V, Brennick JB, Storm CA, et al. Lentigo maligna (melanoma in situ) treated with imiquimod cream 5%: 12 case reports. Cutis. 2007;79:149–52.

    PubMed  Google Scholar 

  • Tanaka M, Sawada M, Kobayashi K. Key points in dermoscopic differentiation between lentigo maligna and solar lentigo. J Dermatol. 2011;38:53–8.

    Article  Google Scholar 

  • Van Meurs T, Van Doorn R, Kirtschig G. Treatment of lentigo maligna with imiquimod cream: a long-term follow-up study of 10 patients. Dermatol Surg. 2010;36:853–8.

    Article  Google Scholar 

  • Walling HW, Scupham RK, Bean AK, Ceilley RI. Staged excision versus Mohs micrographic surgery for lentigo maligna and lentigo maligna melanoma. J Am Acad Dermatol. 2007;57:659–64.

    Article  Google Scholar 

  • Wong J, Toole J, Demers A, Musto G, Wiseman M. Topical 5% imiquimod in the treatment of lentigo maligna. J Cutan Med Surg. 2012;16:245–9.

    Article  CAS  Google Scholar 

  • Woodmansee C, McCall M. Recurrence of lentigo maligna and development of invasive melanoma after treatment of lentigo maligna with imiquimod. Dermatol Surg. 2009;35:1286–9.

    Article  CAS  Google Scholar 

  • Zacarian S. Cryosurgical treatment of lentigo maligna. Arch Dermatol. 1982;118:89–92.

    Article  CAS  Google Scholar 

  • Zalaudek I, Horn M, Richtig E, Hödl S, Kerl H, Smolle J. Local recurrence in melanoma in situ: influence of sex, age, site of involvement and therapeutic modalities. Br J Dermatol. 2003;148:703–8.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Dermatology (Pav. R), Ed. Herriot Hospital Group, Lyon, 69437, France

    Jean Kanitakis

Authors
  1. Jean Kanitakis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jean Kanitakis .

Editor information

Editors and Affiliations

  1. Department of Dermatology, Andreas Syggros Hospital University of Athens, Athens, Greece

    Andreas D. Katsambas  & Clio Dessinioti  & 

  2. University of Rome “G. Marconi”, Rome, Italy

    Torello M. Lotti

  3. Centro Studi per la Ricerca Multidisciplinare Rigenerativa (CSRMR), Rome, Italy

    Torello M. Lotti

  4. Unit of Dermatology, University of Pisa, Pisa, Italy

    Angelo Massimiliano D’Erme

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Kanitakis, J. (2015). Lentigo Maligna. In: Katsambas, A.D., Lotti, T.M., Dessinioti, C., D’Erme, A.M. (eds) European Handbook of Dermatological Treatments. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-45139-7_51

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-45139-7_51

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-45138-0

  • Online ISBN: 978-3-662-45139-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation