Dermatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
Institut de Recerca Sant Pau (IR Sant Pau), Barcelona, Spain.
Ital J Dermatol Venerol. 2024 Aug;159(4):390-411. doi: 10.23736/S2784-8671.24.07837-X.
Lentigo maligna (LM), a form of melanoma in situ, and LM melanoma (LMM), its invasive counterpart, exhibit distinctive epidemiology, risk factors, and clinical features compared to other melanoma subtypes. Notably, LM occurs on chronically sun-damaged skin presenting as a slow-growing, ill-defined patch which makes it difficult to diagnose and to treat. Additionally, while LM generally presents a favourable prognosis, it can also lead to dermal invasion and behave similarly to other melanomas with the same Breslow thickness. Hence, surgery continues to be the cornerstone treatment. Wide excisions are often necessary, but challenges arise when these lesions manifest in cosmetically sensitive regions, limiting the feasibility and desirability of large excisions. Specialized approaches, including margin-controlled surgery and image-guided treatment with reflectance confocal microscopy, have been developed to address these issues. Other non-surgical treatments such as cryosurgery, imiquimod, radiotherapy, or photodynamic therapy, may also be used but commonly present with recurrent/persistent disease. Herein we comprehensively review the existing literature on the management of LM/LMM, and discus the potential new advances on managing this challenging skin cancer.
恶性雀斑样痣（LM），一种原位黑色素瘤，与侵袭性的 LM 黑色素瘤（LMM）相比，其在流行病学、危险因素和临床特征方面与其他黑色素瘤亚型有明显不同。值得注意的是，LM 发生在慢性日光损伤的皮肤上，表现为生长缓慢、边界不清的斑块，这使得诊断和治疗变得困难。此外，虽然 LM 通常预后良好，但它也可能导致真皮侵犯，并表现出与其他具有相同 Breslow 厚度的黑色素瘤相似的行为。因此，手术仍然是基石治疗。广泛切除通常是必要的，但当这些病变出现在美容敏感区域时，就会出现挑战，限制了大切除的可行性和理想性。已经开发了专门的方法，包括边缘控制手术和反射共聚焦显微镜的图像引导治疗，以解决这些问题。其他非手术治疗，如冷冻疗法、咪喹莫特、放疗或光动力疗法，也可用于治疗，但通常会出现疾病复发/持续存在的情况。本文全面回顾了关于 LM/LMM 管理的现有文献，并讨论了管理这种具有挑战性的皮肤癌的潜在新进展。
