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fhea.com Fitzgerald Health Education Associates, Inc., May 2015
ANSWER
The correct diagnosis is lentigo maligna
melanoma (LMM).
The following features, some of which are
dramatically displayed in this case,
characterize LMM:
• Represents the in-situ form of melanoma
(the malignant tumor is still confined to
the top layers of the skin, stage 0).
• Comprises approximately 10% to 15% of
malignant melanoma cases.
• Most frequently manifests itself in the
seventh decade of life.
• Occurs predominantly on sun-exposed
areas, especially the face.
• The lesions contain a brown-black
irregularly shaped macule, which if
untreated will develop into nodular
melanoma, an invasive form of
melanoma.
This form of melanoma displays the
longest radial growth phase. In a pathology
report, the growth phase designation shows
whether the melanoma has reached the step
where it can grow as a lump below the
epidermis. In the radial growth phase, it is
unlikely that the cancer has begun to
metastasize. In the vertical growth phase,
there is some chance that the disease has
spread elsewhere in the body.
The Next Step
Primary care clinicians should refer suspected
cases of LMM to specialists for a definitive
diagnosis. Careful follow-up is required to
ensure that the patient is evaluated and
treated in a timely manner.
•
Victor Czerkasij, MA, MS, FNP-BC, NP-C,
is a Fitzgerald Health Education Associ-
ates Faculty member. He has published
multiple articles on various skin condi-
tions, and has received awards for his
editorial excellence. Victor lectures fre-
quently at national conferences on dermatology top-
ics, and, most of all, enjoys caring for his patients at
the Skin Cancer and Dermatology Center in Cleve-
land, TN. Learn more from Victor and view his cours-
es at
Fitzgerald Dermatology .
Diagnostic Challenge
Photo credit: Provided courtesy of the US Centers for Disease Control and Prevention/Carl
W
ashington, MD, Emory University School of Medicine; Mona Saraiya, MD, MPH.