In vivo confocal microscopy can noninvasively image thin en face sections within living intact human tissue with high resolution and contrast. This evolving technique may provide clinicians with tools to help detect lentigo maligna lesion progression in vivo and may be important in defining tumor margins, thus providing a more definitive surgical eradication of lentigo maligna and malignant mel...

OBJECTIVE To assess outcomes in managing primary lentigo maligna through surgical excision, radiation therapy, and carbon dioxide laser ablation. METHODS Retrospective case series review of all patients with primary lentigo maligna diagnosed and treated in London, Ontario, Canada, between July 2, 1991, and June 29, 2010. RESULTS Seventy-five patients aged 39 to 93 years (mean age, 64.8 year...

A 57-year-old man presented with a solitary flat pigmented lesion on his face, which had appeared two years previously and was slowly enlarging over time. Physical examination revealed a flat pigmented lesion, 8 mm in size, on the patient’s right cheek. The clinical diagnosis was suggestive of a solar lentigo (SL) because of the symmetric shape, the regular border, and the homogenous brown colo...

In this case of secondary syphilis, pustular lesions progressed rapidly to painful ulcerative lesions in a patient with early HIV infection. This rapidly progressive form of early syphilis has historically been called lues maligna praecox, a severe form of noduloulcerative secondary syphilis. Serologic tests for syphilis were positive and biopsy showed forms consistent with Treponema pallidum i...

BACKGROUND Although solar radiation is well established as a risk factor for melanoma, it is less clear how the pattern and timing of exposure to ultraviolet (UV) radiation might be important. The particular objective of this study was to evaluate the association of melanoma risk with various measures of intermittent and chronic exposures to UV radiation, and to assess how these exposures inter...

A case of angiocentric invasion by a lentigo maligna melanoma is reported. Pericapillary cuffing and permeative intimal expansion of veins by melanoma without luminal tumour cell emboli, thrombosis, or vascular destruction were associated with a lentigo maligna melanoma on the face of a 93 year old woman. This unusual infiltrative pattern suggests a specific interaction between melanoma cells a...

Lentigo maligna (LM) is the in situ phase of lentigo maligna melanoma, which may progress to invasive melanoma if left untreated. It mainly occurs on sun-exposed areas of elderly patients. The lesions can be large and conventional surgery can be difficult, particularly on the face. Recent reports indicate that topical imiquimod 5% cream is effective in the treatment of LM. It may be an alternat...

OBJECTIVE To determine if the complete response rates of lentigo maligna (LM) to imiquimod, 5%, cream can be improved by the addition of a topical retinoid. DESIGN Prospective randomized study of patients treated with imiquimod alone vs imiquimod plus a topical retinoid, followed by conservative staged excisions. SETTING Mohs surgical clinic in an academic institution. PATIENTS Ninety pat...

Spontaneous regression of metastatic malignant melanoma is rare. A case is presented here. The primary lesion, a lentigo maligna melanoma of the face, recurred after excision and metastasized to the parotid and upper cervical lymph nodes, and to the lungs. The patient declined further therapy. There was no clinical or radiologic evidence of metastasis 1 year later.

Dermoscopy has its usefulness well established in the diagnostic evaluation of melanocytic lesions. Recently, however, it has also shown to be an important tool in monitoring therapeutic response to various dermatoses. We report the case of an elderly patient diagnosed with lentigo maligna of difficult surgical management, which we have chosen to treat with topical imiquimod. The dermoscopic mo...