Amelanotic Lentigo Maligna Melanoma A Diagnostic Conundrum; Presentation of Four New Cases

Homayoon Rahbari, M.D., Hossein Nabai, M.D., Amir H. Mehregan, M.D., David A. Mehregan, M.D., Darius R. Merhregan, M.D., and Judith Lipinski, M.D.
Background: The clinical appearance of amelanotic lentigo maligna melanoma (ALMM) is quite confusing and usually is not diagnosed prior to histopathologic examination.

Methods: We have studied four new patients with ALMM whose correct diagnosis was not obtained from any one clinical finding. We arrived at the final diagnosis in an unexpected way, having had biopsied the lesions for diagnoses other than malignant melanoma.

Results: ALMM presents as a nonspecific skin lesion with no single indicative characteristic. A search of the literature confirmed our difficulty in making the diagnosis.

Conclusions: To diagnose ALMM, one has to be cognizant of this condition and has to consider a constellation of findings that are unusual with melanocytic lesions. Questionable lesions must be biopsied for definitive histopathologic diagnosis.

KEYWORDS: amelanotic melanoma, lentigo maligna, dermatitic lesions, scaly elevated pruritus.

Cancer 1996; 77:2052-7