Herein we report a case of lentigo maligna that evolved into lentigo maligna melanoma. Fifteen years ago, the patient developed a pigmented lesion on the right cheek. The lesion progressed slowly, and 2 months ago, a black nodular lesion was developed in the periphery of the pigmented lesion. Histopathologic examination of the lesions revealed findings consistent with lentigo maligna and lentigo maligna melanorna. She had been performed wide excision and cheek flap for reconstruction.
Cheek ; Humans ; Hutchinson's Melanotic Freckle* ; Lentigo* ; Melanoma*

Mucosal melanomas are malignant tumors from melanocytes found in epithelium of nasal, oral, reproductive and gastrointestinal mucosa of the body.1,2 As early as 1869, cases of mucosal melanomas have been described as rare and aggressive but insidious in nature.3 The mean age of diagnosis in some studies is 60 - 70 years old,1-7 with early detection proving to be a challenge due to non-specific early stage symptoms.1,4 They generally have poor prognosis, high tumor recurrence and high prevalence of tumor metastasis in around 23 - 50%.4,5 Treatment may involve surgical excision, radiotherapy or chemotherapy.6 However, adequate and appropriate treatment can only be initiated once the diagnosis and staging are established through proper imaging and histopathologic support.4 We present one such case.
malignant melanoma

No abstract available.
Melanoma, Amelanotic* ; Poroma*

No abstract available.
Heel* ; Melanoma, Amelanotic* ; Ulcer*

No abstract available.
Melanoma, Amelanotic* ; Vagina*

We evaluated the characteristics of HMB-45 monoclonal antibody(MoAb) and compared it with a polyclonal anti-S-100 antibody in immunohistochemical staining of 22 primary melanomas of the skin ; 13 acral lentiginous melanomas(ALM), 3 superficial spreading melanomas(SSM), 4 lentigo maligna melanomas(LMM), 3 nodular melanomas(NMM). All speimens were formalin-fixed and paraffin-embedded, and were studied with the avidin-biotin-peroxidase complex technique. The results can be summarized as follows : l. In all tissue specimens, all or some of the melanoma cells in the dermis reacted with HMB-45 MoAb and anti-S-100 protein. 2. HMB-45 MoAb is more sensitive in detecting malignant melanoma cell heterogeneity t,han anti-S-100 protein. 3. Melanoma cells within the epidermis in 6 of 12 ALMs and 3 of 4 LMMs did not react with anti-S-100 antibody, whereas most melanoma cells within epidermis of 12 ALMs and 4 LMMs reacted with HMB-45 monoclonal antibody. These results indicated that immunohistochemical staining with HMB-45 MoAb and anti-S-100 protein is very useful in the study of biologic behavior of malignant, melanoma.
Dermis ; Epidermis ; Hutchinson's Melanotic Freckle ; Melanoma* ; Population Characteristics ; Skin

Desmoplastic malignant melanoma (DMM) is an uncommon variant of malignant melanoma featuring a proliferation of spindle cells with pronounced desmopaasia. DMM commonly occurs on the sun-damaged skin such as head and neck in older persons, and it can be associated with lentigo maligna. We report an unusual case of desmoplastic malignant melanoma that developed de novo on the trunk in a young patient.
Head ; Humans ; Hutchinson's Melanotic Freckle ; Melanoma* ; Neck ; Skin

Lentigo maligna melanoma and lentigo maligna are typically located on photo-exposed sites such as the head and neck, with the cheek being the most common site. Since lentigo maligna melanoma and lentigo maligna are found predominantly on such cosmetically-sensitive areas, it is critical to determine the exact histologic margin for maximal sparing of tissue and complete extirpation of the tumor. Since Mohs micrographic surgery has been recommended for tumors on cosmetically-sensitive locations where the tumor margin is indistinct, it appears to be a reasonable treatment modality for this type of tumor. We describe a case of lentigo maligna melanoma on the cheek, which was resected with Mohs micrographic surgery.
Cheek ; Head ; Hutchinson's Melanotic Freckle* ; Lentigo* ; Melanoma* ; Mohs Surgery* ; Neck

Acral lentiginous melanoma (ALM) is the rarest of the four subtypes of cutaneous melanoma.1 It accounts for only 2-8% of melanomas in caucasians.2 Only 52 cases of ALM have been recorded in the Philippine Dermatological Society Health Information System from 2011 to 2016.3 Histopathologic demonstration of cytologic atypia, presence of mitoses in the deep dermis, pagetoid spread of epidermal melanocytes and lack of maturation of nests with descent into the dermis are features diagnostic of melanoma.2 4 ALM is primarily managed through wide surgical excision. The most common sites for ALM are the soles, palms, and subungual areas.2 The rarity of ALM, the inconspicuousness of the locations of some lesions, and the difficulty in discerning ALM from benign lesions and traumatic changes usually delay the diagnosis and contribute to the poor prognosis of the disease.4 5 6 A 53-year-old male consulted us for an enlarging pigmented plaque on the sole of his left foot. The lesion started as a junctional nevus, which the patient had since birth. The nevus, originally measuring approximately 0.5 x 0.5 cm, started to increase in size one year prior to the consultation. One month before consultation, the patient noted a black nodule on the center of the lesion. A week before consultation, the lesion bled and became painful after manipulation by the patient. Dermatologic examination of the plantar aspect of the left foot revealed a 1.7 x 1.6 cm, dark brown-black, asymmetric plaque with cobblestone-like surface and a black indurated nodule on the center (Figure 1A). Dermoscopic findings of bluish white veil and irregular pigmentation with variable hypopigmented blotches are suggestive of acral melanoma (Figure 1B). Skin punch biopsy and immunohistochemical stains for S100, Melan A, HMB-45, and KI-67 confirmed the diagnosis of ALM (Figure 2, 3). We did a wide local excision of the lesion with a 2-cm margin from the tumor edge, with depth up to the suprafascial level (Figure 4A). The excisional defect was repaired with a split-thickness skin graft taken from the patient’s skin on the right thigh (Figure 6), which provided excellent aesthetic result. We also did a sentinel lymph node biopsy on the left inguinal area (Figure 5A,B). Frozen section biopsy showed solid nests of atypical melanocytes invading the surrounding fibrous stroma. Individual cells exhibit round to oval, deeply basophilic nuclei and abundant, clear to eosinophilic cytoplasm. Some areas showed prominent melanin pigmentation. Sections along lines of resection, lymphovascular channels, nerves and adipose tissues of the excised mass (Figure 4 B,C) and lymph nodes from sentinel biopsy were all devoid of malignant tumor cells. Histopathologic findings from frozen section biopsy and permanent section biopsy were both consistent with malignant melanoma with 3 mm Breslow thickness. The patient’s postoperative course, including wound healing, was uneventful (Figure 7). During the patient’s 12-month follow up period, we did not observe any signs of local or distant recurrence of the tumor.
Melanoma, Cutaneous Malignant ; Skin Transplantation

Acral lentiginous melanoma (ALM) is the rarest of the four subtypes of cutaneous melanoma.1 It accounts for only 2-8% of melanomas in caucasians.2 Only 52 cases of ALM have been recorded in the Philippine Dermatological Society Health Information System from 2011 to 2016.3 Histopathologic demonstration of cytologic atypia, presence of mitoses in the deep dermis, pagetoid spread of epidermal melanocytes and lack of maturation of nests with descent into the dermis are features diagnostic of melanoma.2 4 ALM is primarily managed through wide surgical excision. The most common sites for ALM are the soles, palms, and subungual areas.2 The rarity of ALM, the inconspicuousness of the locations of some lesions, and the difficulty in discerning ALM from benign lesions and traumatic changes usually delay the diagnosis and contribute to the poor prognosis of the disease.4 5 6 A 53-year-old male consulted us for an enlarging pigmented plaque on the sole of his left foot. The lesion started as a junctional nevus, which the patient had since birth. The nevus, originally measuring approximately 0.5 x 0.5 cm, started to increase in size one year prior to the consultation. One month before consultation, the patient noted a black nodule on the center of the lesion. A week before consultation, the lesion bled and became painful after manipulation by the patient. Dermatologic examination of the plantar aspect of the left foot revealed a 1.7 x 1.6 cm, dark brown-black, asymmetric plaque with cobblestone-like surface and a black indurated nodule on the center (Figure 1A). Dermoscopic findings of bluish white veil and irregular pigmentation with variable hypopigmented blotches are suggestive of acral melanoma (Figure 1B). Skin punch biopsy and immunohistochemical stains for S100, Melan A, HMB-45, and KI-67 confirmed the diagnosis of ALM (Figure 2, 3). We did a wide local excision of the lesion with a 2-cm margin from the tumor edge, with depth up to the suprafascial level (Figure 4A). The excisional defect was repaired with a split-thickness skin graft taken from the patient’s skin on the right thigh (Figure 6), which provided excellent aesthetic result. We also did a sentinel lymph node biopsy on the left inguinal area (Figure 5A,B). Frozen section biopsy showed solid nests of atypical melanocytes invading the surrounding fibrous stroma. Individual cells exhibit round to oval, deeply basophilic nuclei and abundant, clear to eosinophilic cytoplasm. Some areas showed prominent melanin pigmentation. Sections along lines of resection, lymphovascular channels, nerves and adipose tissues of the excised mass (Figure 4 B,C) and lymph nodes from sentinel biopsy were all devoid of malignant tumor cells. Histopathologic findings from frozen section biopsy and permanent section biopsy were both consistent with malignant melanoma with 3 mm Breslow thickness. The patient’s postoperative course, including wound healing, was uneventful (Figure 7). During the patient’s 12-month follow up period, we did not observe any signs of local or distant recurrence of the tumor.
Melanoma, Cutaneous Malignant ; Skin Transplantation