Reflectance confocal microscopy of facial lentigo maligna and lentigo maligna melanoma: A preliminary study

V. Ahlgrimm-Siess*, C. Massone, A. Scope, R. Fink-Puches, E. Richtig, I. H. Wolf, S. Koller, A. Gerger, J. Smolle, R. Hofmann-Wellenhof

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

74 Scopus citations

Abstract

Background Facial lentigo maligna (LM) and lentigo maligna melanoma (LMM) may be difficult to diagnose clinically and dermoscopically. Reflectance confocal microscopy (RCM) enables the in vivo assessment of equivocal skin lesions at a cellular level. Objectives To assess cytomorphological and architectural RCM features of facial LM/LMM. Methods Four women and eight men aged 58-88 years presenting with facial skin lesions suspicious of LM/LMM were included. In total, 17 lesion areas were imaged by RCM before biopsy. The histopathological diagnosis of LM was made in 15 areas; the other two were diagnosed as early LMM. Results A focal increase of atypical melanocytes and nests surrounding adnexal openings, sheets of mainly dendritic melanocytes, cord-like rete ridges at the dermoepidermal junction (DEJ) and an infiltration of adnexal structures by atypical melanocytes were found to be characteristic RCM features of facial LM/LMM. Areas with a focal increase of atypical melanocytes and nests surrounding adnexal openings were observed at the basal layer in three cases. The remaining cases displayed these changes at suprabasal layers above sheets of mainly dendritic melanocytes. Cord-like rete ridges at the DEJ and an infiltration of adnexal structures by atypical melanocytes were observed in all cases. Previously described criteria for RCM diagnosis of melanoma, such as epidermal disarray, pleomorphism of melanocytes and pagetoid spreading of atypical melanocytes, were additionally observed. Conclusions We observed a reproducible set of RCM criteria in this case series of facial LM/LMM.

Original languageEnglish
Pages (from-to)1307-1316
Number of pages10
JournalBritish Journal of Dermatology
Volume161
Issue number6
DOIs
StatePublished - Dec 2009
Externally publishedYes

Keywords

  • Dermoscopy
  • In vivoconfocal scanning laser microscopy
  • Lentigo maligna
  • Melanoma
  • Reflectance confocal microscopy
  • Sun-damaged skin

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