Lentigo maligna melanoma is most often seen on the face of patients in their fifth to seventh decades of life, especially in those with a considerable sun exposure history. This type of melanoma can be difficult to treat and has a propensity for local recurrence. The borders of the melanoma are ill defined, and it is difficult to distinguish the background normal sun-damaged melanocytes from the tumor cells.
Amelanotic melanoma is the most difficult of all melanomas to diagnosis. These tumors often appear as slowly enlarging pink patches or plaques with no pigment. They are commonly misdiagnosed as dermatitis or tinea infections, and the diagnosis is often delayed. They can also resemble actinic keratoses. The lack of pigment takes away the clinician’s most important diagnostic clue. These tumors are often biopsied because they have not gone away after being treated for something entirely different or after they have developed a papule or nodule. At that point, they are still most commonly thought to be basal cell carcinomas or squamous cell carcinomas; rarely does the clinician include amelanotic melanoma in the differential diagnosis. Patients with albinism or xeroderma pigmentosum are at a higher risk for development of amelanotic melanoma. These patients need to be screened routinely, and any suspicious lesions should be biopsied.
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