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. 2019 Feb;80(2):532-537.
doi: 10.1016/j.jaad.2018.07.071. Epub 2018 Sep 26.

Follicular involvement is frequent in lentigo maligna: Implications for treatment

Karen L Connolly  1 , Cerrene Giordano  1 , Stephen Dusza  1 , Klaus J Busam  2 , Kishwer Nehal  3
Affiliations

Follicular involvement is frequent in lentigo maligna: Implications for treatment

Karen L Connolly et al. J Am Acad Dermatol. 2019 Feb.

Abstract

Background: Follicular involvement of lentigo maligna (LM) is considered a histopathologic hallmark, but its prevalence and characteristics have not been well defined. The depth of intrafollicular extension by neoplastic melanocytes may have clinical importance in the treatment of LM.

Objective: To describe the prevalence and features of follicular involvement in LM, including depth of follicular growth by melanocytes.

Methods: A single-center retrospective study of 100 consecutive cases of surgically excised LM that was treated from 2013 to 2015. The slide review for cases with residual LM on the debulk specimen was performed by a dermatologic surgeon and dermatopathologist to characterize follicular involvement.

Results: Of 100 specimens, 72 met the inclusion criteria for histopathologic evaluation. Follicular involvement was seen in 95.8% of specimens (95% confidence interval, 88.3%-99.1%), with a mean of 68% of follicles involved in a single specimen. The mean depth of intrafollicular growth by lesional melanocytes was 0.45 mm (standard deviation, 0.23; range, 0.1-1.1 mm). Tumor cells were confined to the infundibular portion of the hair follicle in 60.9% of specimens.

Conclusion: Superficial follicular involvement is a ubiquitous finding in LM. When treatment options for LM with a depth-dependent modality aiming for tumor clearance are being considered, mean and maximum depths of involvement should be taken into consideration.

Keywords: adnexa; follicular involvement; lentigo maligna; melanoma.

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Conflict of interest statement

Conflict of Interest Disclosure: None Declared

Figures

Figure 1.
Figure 1.
A, Lentigo maligna melanoma in situ with follicular involvement. An increased density of solitary units of melanocytes with nuclear atypia is seen at the dermoepidermal follicular dermal junction (arrow) B, Lentigo maligna melanoma in situ with follicular involvement. Nests and solitary units of melanocytes are present at the dermoepidermal and follicular infundibular stromal junction. (A-B Hematoxylin-eosin stain; original magnification: 10x objective)
Figure 1.
Figure 1.
A, Lentigo maligna melanoma in situ with follicular involvement. An increased density of solitary units of melanocytes with nuclear atypia is seen at the dermoepidermal follicular dermal junction (arrow) B, Lentigo maligna melanoma in situ with follicular involvement. Nests and solitary units of melanocytes are present at the dermoepidermal and follicular infundibular stromal junction. (A-B Hematoxylin-eosin stain; original magnification: 10x objective)
Figure 2.
Figure 2.
Boxplot of follicular depth by anatomic site (n=69).
Figure 3.
Figure 3.
Boxplot of proportion of follicles involved per lesion by anatomic site (n=69).
See this image and copyright information in PMC

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