Lentigo Maligna: What's New

Lentigo maligna is characterized as a flat macule often observed in elderly patients, particularly on the face and neck, and represents an intradermal melanoma with lentiginous proliferation. The presentation can vary by gender; females typically have lesions on their cheeks, while males often present with them in cartilaginous areas. Diagnosis can be complicated due to the overlapping features with benign conditions like solar lentigo, which are common in light-skinned individuals. Recent studies highlight that some lentigo maligna lesions are misdiagnosed as benign before being properly identified as malignant. Treatments aimed at cosmetic improvement, such as laser therapy, can exacerbate the issue by allowing lesions to become invasive melanomas. The exploration of lentigo maligna in younger patients (under 50) has revealed that some cases exist in those as young as 30, although initial presentations may not be large. Dermoscopy reveals key features of lentigo maligna, helping differentiate it from benign lesions; for example, asymmetric pigmented follicular openings are considered a critical sign. Moreover, new diagnostic criteria have emerged, including perifollicular linear projections. Improved diagnostic accuracy, especially utilizing confocal microscopy, can facilitate better identification of melanoma, emphasizing the importance of comprehensive assessments combining clinical, dermoscopic, and histopathological findings. A consensus among experts underscores the necessity of integrating these various diagnostic modalities to avoid misdiagnoses. Upcoming dermatology congresses aim to further disseminate knowledge regarding these issues.