Lentigo Maligna

Lentigo maligna is a precancerous skin condition and a precursor to lentigo maligna melanoma, an invasive and serious type of skin cancer. Exposure of the skin to the sun is the primary risk factor for developing lentigo maligna. Lentigo maligna is typically slow-growing and is usually harmless, but lentigo maligna melanoma can become aggressive and spread rapidly. Recognizing the symptoms of this skin condition is critical for seeking treatment early on. Contact our dermatologists in Gainesville with Gainesville Dermatology & Skin Surgery to schedule an appointment and to learn more about our available treatments for an encompassing range of skin conditions.

Contact our Gainesville dermatology practice today to schedule a dermatology appointment and to learn more about treatment for lentigo maligna, lentigo maligna melanoma, and other skin conditions.

What Is Lentigo Maligna?

Lentigo maligna, sometimes called Hutchinson's melanotic freckle, is a precancerous skin condition and a precursor to lentigo maligna melanoma, a dangerous form of skin cancer. In this early form of skin cancer, the malignant cells are confined to the epidermis, the skin's outer surface. When it starts growing under the skin's surface, it develops into maligna melanoma, the least common type of melanoma. Lentigo maligna occurs in sun-damaged skin and is generally found on the neck and face, especially on the nose and cheeks.

This precancerous skin condition is usually harmless and slow-growing, often expanding in diameter over 5–20 years. Lentigo maligna melanoma, however, can spread aggressively. It is important to recognize the symptoms of these conditions for treatment as early as possible.

Who Gets Lentigo Maligna?

The risk of lentigo maligna relates closely with sun damage to skin. As such, lentigo maligna is more common in those who spend a significant amount of time outdoors, those who work outdoors, older individuals, and those associated with solar damage and basal cell carcinoma and squamous cell carcinoma (keratinocyte skin cancer). Although lentigo maligna often occurs in people with very fair skin, it can also occur in those with any skin type and tone variation.

It is rare, however, in those with brown and black skin. Lentigo maligna is typically more common in males than in females. Most patients diagnosed with lentigo maligna are older than 40 years of age, with the peak age of diagnosis ranging from 60–80 years of age. Unlike other forms of melanoma and precancerous skin conditions, lentigo maligna is not related to a person's number of moles or atypical moles.

What Does Lentigo Maligna Look Like?

The visual symptoms of lentigo maligna are similar to those of lentigo maligna melanoma. These conditions appear as a flat or somewhat raised brown patch on the skin, similar to a freckle or an age spot. These lesions have a smooth surface with an irregular shape or border. They are usually a shade of brown, though they may also be pink, red, or white. Compared with other types of skin cancer, lentigo maligna and lentigo maligna melanoma produce large-sized lesions. The lesions are usually a minimum of 6 millimeters wide and can grow to encompass several centimeters of skin.

It most commonly presents on the face or neck, especially the nose and cheeks, though it can appear elsewhere on the body. Due to its appearance, it can be difficult to distinguish lentigo maligna and lentigo maligna melanoma from freckles or age spots just by looking at the lesion. It can also be difficult to visually differentiate between lentigo maligna and lentigo maligna melanoma. Lentigo maligna melanoma usually features increased thickness, multiple colors (black and blue), bleeding, itching, and stinging.

What Causes Lentigo Maligna?

The exact cause of lentigo maligna is unknown; however, sun exposure is the most significant risk factor for developing this condition and lentigo maligna melanoma. Individuals with sun-damaged skin and those who spend a significant amount of time outside are at a higher risk for developing these conditions. What triggers the malignant pigment cells to become malignant is unknown, but genetic mutations may begin with primitive stem cells. When sun damage occurs, abnormal cells can grow unregulated. Other risk factors for developing lentigo maligna and lentigo maligna melanoma include the following.

Very fair or light skin
A family history of skin cancer
Assigned male at birth
Being over the age of 60
Having a history of noncancerous or precancerous skin conditions

How Is Lentigo Maligna Diagnosed?

It is critical that lentigo maligna and lentigo maligna melanoma are diagnosed early and accurately. After reviewing your medical history and performing a physical exam, your Gainesville dermatologist may recommend several tests to determine your diagnosis. They may perform a lentigo maligna dermoscopy, which combines a magnifying lens with a bright light to view the lesion more closely. Your dermatologist may also perform a diagnostic excision biopsy, which involves removing all or a piece of your lesion to test for cancer cells. If your lesion is suspected of being lentigo maligna melanoma, your doctor may perform a sentinel lymph node biopsy to see how far it has spread.

During this procedure, the doctor removes a number of nearby lymph nodes and then tests them for cancer. A CT scan or an MRI scan may also be useful for determining any signs of spreading. If you are diagnosed with lentigo maligna melanoma, your doctor will determine the stage of the condition, reflecting how serious it is. The thickness of the lesion, or Breslow's thickness, helps your dermatologist determine the skin cancer stage. The Clark level of invasion, used to determine the number of skin layers involved in the cancer, can also help determine it's stage. There are five stages of skin cancer, ranging from 0–4, with zero being the earliest and least-serious cancer stage.

Lentigo Maligna Treatment

The most common treatment for lentigo maligna is surgical excision, which means surgically cutting out the lesion, and any affected tissues nearby, followed by closing the wound with a flap or skin grafting. Similarly, the most common treatment for lentigo maligna melanoma is skin cancer surgery. In addition to lentigo maligna removal through surgical excision, other treatments may be considered if it is difficult to remove the lesion surgically, if the surgery will be deforming, or if there is a significant contraindication (a reason why a treatment, procedure, or investigation is inadvisable) to surgical removal. Please contact our office for information about available treatment options for lentigo maligna and lentigo maligna melanoma.

What Are The Complications Of Lentigo Maligna?

If left untreated, lentigo maligna can eventually develop into lentigo maligna melanoma. Untreated lentigo maligna melanoma can then spread throughout the body. As such, identifying the disease and treating it as early as possible is of critical importance. The more the cancer spreads, the more difficult it is to treat. In some situations, surgical excision of the lesion may have cosmetic complications, as the lesions usually occur in areas of high visibility, such as the neck and the face. Discuss your treatment options with your dermatologist. Depending on the exact location of the lentigo maligna, they can help minimize the visible effects of the surgery using a variety of specialized surgical techniques.

How Can I Prevent Lentigo Maligna Melanoma?

There is no proven method to completely prevent lentigo maligna and lentigo maligna melanoma. However, the best way to prevent these conditions is to limit your exposure to ultraviolet rays from the sun and avoid the use of tanning and tanning beds. If and when you do spend time outdoors while the sun is out, be proactive by applying a high-SPF, broad-spectrum sunscreen and reapplying it throughout the day. Choose sun-protective clothing with a UPF rating over non-protective clothing items. Wear large, wide-brimmed hats that protect your face and neck as well as protective eyewear. Another critical prevention tip is to actively monitor any changes in your skin by getting annual (or even more frequent) skin examinations from your dermatologist. Contact Gainesville Dermatology & Skin Surgery today to schedule it.