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Case Reports
. 2017 Jul 19;5(4):458-461.
doi: 10.3889/oamjms.2017.113. eCollection 2017 Jul 25.

Very Rare Amelanotic Lentigo Maligna Melanoma with Skull Roof Invasion

Uwe Wollina  1 , Gesina Hansel  1 , Nadine Schmidt  1 , Jacqueline Schönlebe  2 , Thomas Kittner  3 , Andreas Nowak  4
Affiliations
Case Reports

Very Rare Amelanotic Lentigo Maligna Melanoma with Skull Roof Invasion

Uwe Wollina et al. Open Access Maced J Med Sci. .

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.

Keywords: Melanoma; amelanotic lentigo malignant melanoma; follow-up; relapses; skull invasion; surgery.

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Figures

Figure 1
Figure 1
Amelanotic lentigo malignant melanoma of the bald head. (a) Initial presentation of the primary tumour resembling squamous cell carcinoma; (b) Relapse on the borders of the transplant, telangiectasias but again no pigmentation at all; (c) Surgical specimen; (d) Defect before closure with skull roof invasion located centrally
Figure 2
Figure 2
Histopathology of lentigo malignant melanoma. (a) Overview (hematoxylin-eosin x 2); (b) detail (hematoxylin-eosin x 4); (c) immunoperoxidase staining for S100 (x4)
Figure 3
Figure 3
Skull defect in magnetic resonance imaging
Figure 4
Figure 4
Four weeks after sandwich transplantation with a stable graft
See this image and copyright information in PMC

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