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Lentigo Maligna

In situ form of melanoma occurring on chronically sun-exposed skin with potential for invasive transformation requiring careful excision.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Dermatoloji department. Book Appointment →

What is Lentigo Maligna?

Lentigo maligna (LM) is melanoma in situ on chronically photodamaged skin, characterized by atypical melanocyte proliferation along the dermo-epidermal junction. It occurs predominantly on the head and neck of fair-skinned elderly patients (mean age 65-75) and accounts for 4-15% of all melanoma cases.

Pathogenesis involves cumulative UV-induced DNA damage with mutations in KIT (more common than in superficial spreading melanoma), BRAF and NRAS. Histologically shows confluent atypical melanocytes along basal layer with adnexal extension and solar elastosis. Once dermal invasion occurs, it is termed lentigo maligna melanoma (LMM).

Diagnosis is challenging due to subtle pigmentation, irregular borders and overlap with benign lentigines. Dermoscopy reveals asymmetric pigmented follicular openings, gray dots and rhomboidal structures. Biopsy with histopathologic confirmation including immunohistochemistry (Melan-A, SOX10) is essential. Treatment options include wide local excision with 5-10 mm margins or staged margin-controlled excision (slow Mohs), imiquimod 5% cream for non-surgical candidates and radiotherapy for poor surgical candidates. Long-term surveillance is critical due to recurrence risk.

Symptoms

Slowly enlarging tan-brown to dark macule
Irregular borders with notching
Color variegation (tan, brown, black)
Diameter typically >6 mm at presentation
Location on chronically sun-exposed face/neck
Asymmetry and uneven pigmentation
Possible nodule formation (invasive transformation)
Often present for years before diagnosis

Risk Factors

Advanced age (>60 years)
Fair skin (Fitzpatrick I-II)
Chronic UV exposure (occupational, recreational)
Multiple solar lentigines and actinic keratoses
History of non-melanoma skin cancer
Family history of melanoma
Immunosuppression
MC1R red hair gene variants

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • New pigmented lesion on chronically sun-exposed skin
  • Slowly enlarging dark macule on face/neck
  • Color or border irregularity
  • Personal or family history of melanoma
  • Multiple atypical pigmented lesions
  • Nodule arising in pigmented macule
  • Annual full-body skin examination if high risk
  • Ulceration or bleeding in pigmented lesion

Treatment Methods

01
Wide local excision with 5-10 mm clinical margins
02
Staged margin-controlled excision (slow Mohs) for facial lesions
03
Mohs micrographic surgery with melanocyte staining
04
Imiquimod 5% cream for elderly non-surgical candidates
05
Radiotherapy for inoperable or poor surgical candidates
06
Sentinel lymph node biopsy if invasive component present
07
Annual full-body skin examination for life
08
Sun protection (SPF 50+, hat, clothing) and education

Which Department to Visit?

You can visit our Dermatoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.