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small lentiginous melanocytic proliferations in older patients (60 +)

Thu, 03/19/2009 - 16:31 — Hina A Sheikh MD

I'm reluctant do diagnose these as nevi, but they are small, well-demarcated and clearly not melanoma. In the absence of cytologic atypia and other features of LM, how do others diagnose such lesions?

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Lentiginous melanocytic proliferations
by Muammar Arida M.D. on Sat, 03/21/2009 - 21:40


The variability of these lesion is quite remarkable and the diganosis depends on multiple factors including the size, well-demarcation, the degree of confluence or nesting (if any), involvment of adnexal epithelium, the presence of absence or presence of solar elastosis as a sign of sun-damage and the type of the biopsy (most importantly whether you see the entire lesion or only a small part). The spectrum of diagnoses that we use in my institution for these types of lesions ranges from lentigo or junctional lentiginous nevus to early MIS, lentigo maligna type but also includes a dizzying array of such ambiguous or noncommittal "hedgy" diagnoses as:

  • Dysplastic junctional and lentiginous nevus with atypia that ranges from slight to severe (if there is at least some nesting). One of the codes about severe atypia mentions that this lesion borders on an in-situ melanoma but is not diagnostic in this specimen or an early stage in the development of melanoma in situ can not be rule out...
  • Atypical junctional and lentiginous melanocytic proliferation... and in comment: This could be an early stage in the development of MIS
  • Solar lentigo with increased number of melanocytes... this is thought to be melanocytic hyperplasia related to sun-damage but if it's part of a larger lesion, f/u etc...
  • Atypical solar lentigo... (in the comment, this could be seen in UVA-induced lentgines... there is also concern for an early lentigo maligna... If this part of a larger pigmented lesion, correlation with the clinical findings and additional biopsies may help...)