Very Rare Amelanotic Lentigo Maligna Melanoma with Skull Roof Invasion

Uwe Wollina; Gesina Hansel; Nadine Schmidt; Jacqueline SchÃ¶nlebe; Thomas Kittner; Andreas Nowak

doi:10.3889/oamjms.2017.113

Authors

Uwe Wollina Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt in Dresden, Dresden
Gesina Hansel Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt in Dresden, Dresden
Nadine Schmidt Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt in Dresden, Dresden
Jacqueline SchÃ¶nlebe StÃ¤dtisches Klinikum Dresden - Institute of Pathology "Georg Schmorl", Dresden
Thomas Kittner Stadtisches Klinikum Dresden, Department of Radiology, Dresden, Sachsen
Andreas Nowak Department of Anesthesiology & Intensive Care Medicine, Emergency Medicine & Pain Management, Hospital Dresden-Friedrichstadt, Academic Teaching Hospital of the Technical University of Dresden, Friedrichstrasse 41, 01067, Dresden

DOI:

https://doi.org/10.3889/oamjms.2017.113

Keywords:

Melanoma, amelanotic lentigo malignant melanoma, relapses, surgery, skull invasion, follow-up

Abstract

BACKGROUND: Lentigo malignant melanoma is a melanoma subtype of chronic sun-damaged skin in elderly Caucasians. Amelanotic variants of lentigo malignant are extremely rare.

CASE PRESENTATION: This is a case report of an 80-year-old male patient who presented with a non-pigmented exophytic tumour of his bald head. After complete surgical excision under the suspicion of squamous cell carcinoma, three-dimensional histologic examination confirmed an amelanotic lentigo malignant melanoma with a tumour thickness of 1.76 mm, resected R0. Five years later he developed the first relapse, the other year a satellite metastasis was surgically removed. One year later, this patient had developed a large relapsing lentigo malignant melanoma with skull roof invasion. There was no evidence of distant metastatic spread. Amelanotic lentigo malignant melanoma is a very rare tumour.

CONCLUSIONS: Serial excision or slow Mohs and Mohs micrographic surgery are the treatments of choice especially in the head and neck area. These tumours may be locally very aggressive as it is shown by skull invasion in the present case.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

JuhÃ¡sz ML, Marmur ES. Reviewing challenges in the diagnosis and treatment of lentigo maligna and lentigo-maligna melanoma. Rare Cancers Ther. 2015;3:133-145. https://doi.org/10.1007/s40487-015-0012-9 PMid:27182482 PMCid:PMC4837936

Kvaskoff M, Siskind V, Green AC. Risk factors for lentigo maligna melanoma compared with superficial spreading melanoma: a case-control study in Australia. Arch Dermatol. 2012;148(2):164-170. https://doi.org/10.1001/archdermatol.2011.291 PMid:22004881

Greveling K, Wakkee M, Nijsten T, van den Bos RR, Hollestein LM. Epidemiology of lentigo maligna and lentigo maligna melanoma in the Netherlands, 1989-2013. J Invest Dermatol. 2016;136(10):1955-1960. https://doi.org/10.1016/j.jid.2016.06.014 PMid:27349862

Christensen KN, Hochwalt PC, Hocker TL, Roenigk RK, Brewer JD, Baum CL, Otley CC, Arpey CJ. Comparison of MITF and Melan-A immunohistochemistry during Mohs surgery for lentigo maligna-type melanoma in situ and lentigo maligna melanoma. Dermatol Surg. 2016;42(2):167-175. https://doi.org/10.1097/DSS.0000000000000600 PMid:26771682

Jaimes N, Marghoob AA, Rabinovitz H, Braun RP, Cameron A, Rosendahl C, Canning G, Keir J. Clinical and dermoscopic characteristics of melanomas on nonfacial chronically sun-damaged skin. J Am Acad Dermatol. 2015;72(6):1027-1035. https://doi.org/10.1016/j.jaad.2015.02.1117 PMid:25824275

Bollea-Garlatti LA, Galimberti GN, Galimberti RL. Lentigo maligna: keys to dermoscopic diagnosis. Actas Dermosifiliogr. 2016;107(6):489-497. https://doi.org/10.1016/j.ad.2016.01.001 PMid:26875792

Guitera P, Moloney FJ, Menzies SW, Stretch JR, Quinn MJ, Hong A, Fogarty G, Scolyer RA. Improving management and patient care in lentigo maligna by mapping with in vivo confocal microscopy. JAMA Dermatol. 2013;149(6):692-698. https://doi.org/10.1001/jamadermatol.2013.2301 PMid:23553208

Wollina U. One-stage reconstruction of soft tissue defects with the sandwich technique: Collagen-elastin dermal template and skin grafts. J Cutan Aesthet Surg. 2011;4(3):176-182. https://doi.org/10.4103/0974-2077.91248 PMid:22279382 PMCid:PMC3263127

Kaufmann R, Nikelski K, Weber L, Sterry W. Amelanotic lentigo maligna melanoma. J Am Acad Dermatol. 1995;32(2 Pt 2):339-342. https://doi.org/10.1016/0190-9622(95)90399-2

Cliff S, Otter M, Holden CA. Amelanotic lentigo maligna melanoma of the face: a case report and review of the literature. Clin Exp Dermatol. 1997;22(4):177-179. https://doi.org/10.1111/j.1365-2230.1997.tb01056.x PMid:9499607

Allan SJ, Dicker AJ, Tidman MJ, McLaren KM, Hunter JA. Amelanotic lentigo maligna and amelanotic lentigo maligna melanoma: a report of three cases mimicking intraepidermal squamous carcinoma. J Eur Acad Dermatol Venereol. 1998;11(1):78-81. https://doi.org/10.1111/j.1468-3083.1998.tb00961.x PMid:9731974

Conrad N, Jackson B, Goldberg L. Amelanotic lentigo maligna melanoma: a unique case presentation. Dermatol Surg. 1999;25(5):408-411. https://doi.org/10.1046/j.1524-4725.1999.08271.x PMid:10469082

Rocamora V, Puig L, RomanÃ J, de Moragas JM. Amelanotic lentigo maligna melanoma: report of a case and review of the literature. Cutis. 1999;64(1):53-56. PMid:10431675

Abdulla FR, Kerns MJ, Mutasim DF. Amelanotic lentigo maligna: a report of three cases and review of the literature. J Am Acad Dermatol. 2010;62(5):857-860. https://doi.org/10.1016/j.jaad.2009.06.017 PMid:19766347

Perera E, Mellick N, Teng P, Beardmore G. A clinically invisible melanoma. Australas J Dermatol. 2014;55(3):e58-e59. https://doi.org/10.1111/ajd.12022 PMid:23425084

Bub JL, Berg D, Slee A, Odland PB. Management of lentigo maligna and lentigo maligna melanoma with staged excision: a 5 year follow up. Arch Dermatol. 2004;140(5):552â€“558. https://doi.org/10.1001/archderm.140.5.552 PMid:15148099

Felton S, Taylor RS, Srivastava D. Excision margins for melanoma in situ on the head and neck. Dermatol Surg. 2016;42(3):327-334. https://doi.org/10.1097/DSS.0000000000000648 PMid:26866286

Wilson JB, Walling HW, Scupham RK, Bean AK, Ceilley RI, Goetz KE. Staged excision for lentigo maligna and lentigo maligna melanoma: analysis of surgical margins and long-term recurrence in 68 cases from a single practice. J Clin Aesthet Dermatol. 2016;9(6):25-30. PMid:27386048 PMCid:PMC4928453

Walling HW, Scupham RK, Bean AK, Ceilley RI. Staged excision versus Mohs micrographic surgery for lentigo maligna and lentigo maligna melanoma. J Am Acad Dermatol. 2007;57(4):659-664. https://doi.org/10.1016/j.jaad.2007.02.011 PMid:17870430

McKenna JK, Florell SR, Goldman GD, Bowen GM. Lentigo maligna/lentigo maligna melanoma: current state of diagnosis and treatment. Dermatol Surg. 2006;32(4):493-504. https://doi.org/10.1097/00042728-200604000-00003

Tio D, van der Woude J, Prinsen CA, Jansma EP, Hoekzema R, van Montfrans C. A systematic review on the role of imiquimod in lentigo maligna and lentigo maligna melanoma: need for standardization of treatment schedule and outcome measures. J Eur Acad Dermatol Venereol. 2017;31(4):616-24. PMid:27987308.

Hedblad MA, Mallbris L. Grenz ray treatment of lentigo maligna and early lentigo maligna melanoma. J Am Acad Dermatol. 2012;67(1):60-68. https://doi.org/10.1016/j.jaad.2011.06.029 PMid:22030019

Gajdos C, McCarter MD. Debulking surgery in advanced melanoma. Expert Rev Anticancer Ther. 2011;11(11):1703-1712. https://doi.org/10.1586/era.11.98 PMid:22050019

Mantas D, Tsaparas P, Charalampoudis P, Gogas H, Kouraklis G. Emergency surgery for metastatic melanoma. Int J Surg Oncol. 2014;2014:987170. https://doi.org/10.1155/2014/987170

Guitera P, Moloney FJ, Menzies SW, Stretch JR, Quinn MJ, Hong A, Fogarty G, Scolyer RA. Improving management and patient care in lentigo maligna by mapping with in vivo confocal microscopy. JAMA Dermatol. 2013;149(6):692-698. https://doi.org/10.1001/jamadermatol.2013.2301 PMid:23553208

Wollina U, Tchernev G. Advanced basal cell carcinoma. Wien Med Wochenschr. 2013;163(15-16):347-353. https://doi.org/10.1007/s10354-013-0193-5 PMid:23589318

Wollina U, Bayyoud Y, KrÃ¶nert C, Nowak A. Giant epithelial malignancies (Basal cell carcinoma, squamous cell carcinoma): a series of 20 tumors from a single center. J Cutan Aesthet Surg. 2012;5(1):12-19. https://doi.org/10.4103/0974-2077.94328 PMid:22557850 PMCid:PMC3339122

Wollina U, Bayyoud Y, Kittner T, DÃ¼rig E. Giant tricholemmal squamous cell carcinoma with cranial infiltration. J Clin Aesthet Dermatol. 2011;4(4):34-37. PMid:21532876 PMCid:PMC3084608

Soma PF, Chibbaro S, Makiese O, Marsella M, Diemidio P, Fricia M, Passanisi M, Catania V, SiragÃ² P, Ventura F. Aggressive scalp carcinoma with intracranial extension: a multidisciplinary experience of 25 patients with long-term follow-up. J Clin Neurosci. 2008;15(9):988-992. https://doi.org/10.1016/j.jocn.2007.09.014 PMid:18653348

Abo Sedira M, Amin AA, Rifaat MA, El-Sebai HI, El-Badawy MA, Aboul Kassem HA. Locally advanced tumors of the scalp: the Egyptian National Cancer Institute experience. J Egypt Natl Canc Inst. 2006;18(3):250-257. PMid:17671535