Longo Caterina, Sticchi Alberto, Curti Alex, Kaleci Shaniko, Moscarella Elvira, Argenziano Giuseppe, Thomas Luc, Guitera Pascale, Huang Chen, Tiodorovic Danica, Apalla Zoe, Peris Ketty, Del Regno Laura, Guida Stefania, Lallas Aimilios, Kittler Harald, Pellacani Giovanni, Navarrete-Dechent Cristian
Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.
Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Skin Cancer Center, Reggio Emilia, Italy.
Clin Exp Dermatol. 2024 Jan 25;49(2):128-134. doi: 10.1093/ced/llad325.
Lentigo maligna/lentigo maligna melanoma (LM/LMM) is usually diagnosed in older patients, when lesions are larger. However, it is important to detect it at an earlier stage to minimize the area for surgical procedure.
To determine and define clinical, dermoscopic and reflectance confocal microscopy (RCM) features of LM/LMM in patients < 50 years old.
This was a multicentre study involving tertiary referral centres for skin cancer management. The study included cases of consecutively excised LM/LMM arising in patients < 50 years of age with a histopathological diagnosis of LM/LMM and a complete set of clinical and dermoscopic images; RCM images were considered when present.
In total, 85 LM/LMM of the face from 85 patients < 50 years were included in the study. A regression model showed a direct association with the size of the lesion (R2 = 0.08; P = 0.01) and with the number of dermoscopic features at diagnosis (R2 = 0.12; P < 0.01). In a multivariable analysis, an increasing number of dermoscopic features correlated with increased patient age (P < 0.01), while the presence of grey colour was a predictor of younger age at diagnosis (P = 0.03). RCM revealed the presence of melanoma diagnostic features in all cases (pagetoid cells and atypical nesting).
LM is not a disease limited to older people as previously thought. LM presenting in young adults tends to be smaller and with fewer dermoscopic features, making its diagnosis challenging. Careful evaluation of facial pigmented lesions prior to cosmetic procedures is imperative to avoid incorrectly treating early LM as a benign lesion.
恶性雀斑样痣/恶性雀斑样痣黑色素瘤（LM/LMM）通常在老年患者病变较大时被诊断出来。然而，早期检测它对于最小化手术面积很重要。
确定并定义50岁以下患者LM/LMM的临床、皮肤镜和反射式共聚焦显微镜（RCM）特征。
这是一项涉及皮肤癌管理三级转诊中心的多中心研究。该研究纳入了50岁以下患者连续切除的LM/LMM病例，这些病例经组织病理学诊断为LM/LMM，并拥有完整的临床和皮肤镜图像；如有RCM图像也一并考虑。
该研究共纳入了85例50岁以下患者面部的85例LM/LMM。一个回归模型显示与病变大小直接相关（R2 = 0.08；P = 0.01），与诊断时皮肤镜特征数量也直接相关（R2 = 0.12；P < 0.01）。在多变量分析中，皮肤镜特征数量增加与患者年龄增长相关（P < 0.01），而灰色的存在是诊断时年龄较小的一个预测因素（P = 0.03）。RCM在所有病例中均显示出黑色素瘤的诊断特征（派杰样细胞和非典型巢状结构）。
LM并非如之前所认为的那样是一种仅限于老年人的疾病。年轻成年人中出现的LM往往较小且皮肤镜特征较少，这使其诊断具有挑战性。在进行美容手术之前，对面部色素沉着病变进行仔细评估至关重要，以避免将早期LM错误地当作良性病变治疗。
