Hutchinson's Lentigo

INTRODUCTION

AKA Hutchinson's melanotic freckle.
AKA Lentigo Maligna.
FYI: Named for Sir Jonathan Hutchinson, a 19th century highly versatile surgeon who was mentored by Paget.  He had an interest in syphilis and it is said he saw >1 million syphilitics in his lifetime.  He published 1200 medical articles, was president of at least 8 royal medical societies, and was said to be obstinate, humourless, unfashionable and immensely knowledgeable.  He also produced a vast collection of medical illustrations, acquired by Osler for Hopkins.  The lentigo was described in 1892.  He died at 85 and elected to choose his own epitaph: "A Man of Hope and Forward-Looking Mind".

See also the Lentigo Maligna Melanoma info in the melanoma card.

D E A B M I M


EPIDEMIOLOGY
Peaks in 70-80s, mostly after the age of 60.
Increasing incidence.
Slight F>M.

Risk Factors
BCCs
Severe sunburns
Light skin colour / red-hair / poor-tanners
Werner syndrome
Xeroderma pigmentosum

D E A B M I M
 

AETIOLOGY

Is thought to be pre-cancerous (probably melanoma-in-situ).

Pathogenesis
Occurs on sun exposed skin, thought to be caused by long-term UV injury.
D E A B M I M
 

BIOLOGICAL BEHAVIOUR

Terminology
Called Lentigo Maligna when confined to epidermis.
Becomes Lentigo Maligna Melanoma when it invades the dermis.

Natural History
Usually present 5-15 yrs before invasive disease begins.
Estimated risk of conversion is 4.7% at age 45 and 2.2% at 65yrs.

Complications

D E A B M I M
 

MANIFESTATIONS

Symptoms

Local

Slow growing pigmented lesion.
- usually tan-brown
- may have irregular pigmentation
Mostly occurs on head and neck
- predilection for nose and cheek
Less commonly arm, leg, trunk.

Metastatic

See melanoma

Signs
Features of Concern
Palpable lesion (low sensitivity for early invasion)
A nodule correlates strongly.
Increasing diametre correlates.
Changing pigmentation
- central dark areas
- halos of pigment
- variegation
D E A B M I M


INVESTIGATIONS

See below
D E A B M I M


MANAGEMENT

Evidence Points
1. There are no prospective studies or RCTs to guide management
2. Biopsy is best means to establish diagnosis.
- biopsy any changing pigmented lesion on the face


Operative

Local excision
Excise confirmed lesions to a narrow margin of clear skin initially.
- performed if result will not be too cosmetically unacceptable.
Else excision biopsy of the concerning area within the lentigo.
Melanoma found
Manage as per melanoma.

Non-Operative
Where excision not possible, e.g. severe comorbidities, cryotherapy has been used (with high recurrence rates).
Radiation may be attempted when excision highly problematic
Topical treatments cannot be recommended.

D E A B M I M


REFERENCES
Browse 4th
Heniford et-al (emedicine).