Dubreuilh’s melanoma

Dubreuilh’s melanoma

Characteristics of Dubreuilh’s melanoma:

It was indeed a Dubreuilh melanoma : a pigmented, inhomogeneous spot, ranging from black to dark brown, which resembles an age spot. It spreads very slowly over several years, or even decades, over areas exposed to the sun (mainly the face) in the elderly.

1. Clinical aspect :
   • It starts as a brown or black spot, often irregular, large in size and with ill-defined contours.
   • Its progression is slow, evolving over several years before becoming invasive.
   • It can vary in color with shades of brown, black, gray, or sometimes blue or red.
2. Location :
   • This type of melanoma is frequently seen on areas that are most exposed to the sun, such as the face, ears, neck, décolleté and hands.
   • It mainly affects older adults with fair skin and a history of prolonged exposure to ultraviolet (UV) rays.
3. Evolution :
   • Lentigo malignant melanoma evolves from a pre-existing lesion, called lentigo malignant, which is an in situ form of melanoma. This means that it is confined to the epidermal (superficial) layer of the skin.
   • Without treatment, it can become invasive, penetrating into the deeper layers of the skin and increasing the risk of metastases.

Diagnosis:

It is a relative diagnostic and therapeutic emergency. A dermatological consultation must be organized within a month for surgical excision and histopathological examination. The treatment will depend on the histopathological examination. Biopsy is generally not appropriate, an immediate excision is preferable. It can be done with a dermatologist but also with an ENT or a plastic surgeon if there is difficulty in finding an appointment and strong diagnostic suspicion. You can take advantage of this consultation to carry out a complete skin examination to look for other cancerous or precancerous lesions. It is useful to look for satellite lymphadenopathy in the superficial areas of cervicofacial drainage.

The diagnosis of Dubreuilh’s melanoma is based on several elements:

1. Clinical examination : The dermatologist looks for the distinguishing signs of a suspicious pigmented spot, including its asymmetry, irregular edges, inhomogeneous color, and evolution over time (ABCDE criteria).
2. Dermatoscopy : A dermatoscope examination allows the internal structure of the lesion to be observed and specific signs associated with melanoma to be identified.
3. Biopsy : To confirm the diagnosis, a biopsy of the lesion is performed and analyzed in the laboratory to assess whether melanoma is present and invasive.

Treatment:

The main treatment for lentigo malignant melanoma is surgical. Options include:

1. Surgical excision :
   • The lesion is removed with a safety margin to ensure that all cancer cells have been removed.
   • If the melanoma is invasive, more extensive surgery with a larger margin is required.
2. Laser therapy :
   • In some cases where surgery is not possible, especially on the face, laser treatments may be considered to treat early lesions.
3. Immunotherapy or targeted therapy :
   • In advanced or metastatic forms, treatments such as immunotherapy or targeted therapies may be offered to slow the progression of the disease.

Prognosis:

The prognosis for Dubreuilh’s melanoma depends on the stage at which it is diagnosed. When detected and treated at an early stage (in situ), the cure rate is very high. On the other hand, once it becomes invasive, the risk of metastasis and complications increase.

Prevention:

• Insist to your patient on photoprotection measures. The recommendations of the American Academy of Dermatology are Sun protection : Prevention involves strict sun protection (sunscreen, protective clothing, hats) to limit exposure to UV rays, the main cause of this type of melanoma:
  • Seeking shade;
  • Avoid exposure from 10 a.m. to 4 p.m.;
  • Wear a sunscreen with an SPF (“sunburn protection factor” = sun protection factor) of at least 15, 15 to 30 minutes before exposure and reapply every 2 hours outdoors even on cloudy days;
  • Wearing light, long, tightly knitted clothes, wide hat;
  • No tanning outdoors or in a UV booth.
• Your patient should be strongly encouraged to notify her 1st degree relatives once the diagnosis of melanoma has been made in order to offer them screening.
• Dermatological monitoring : People at risk (fair skin, family history of melanoma, heavy sun exposure) should see a dermatologist regularly to monitor for pigmented lesions.

In short:

Dubreuilh melanoma is a form of melanoma that grows slowly, often in older people on sun-exposed areas. Although it has a prolonged non-invasive phase, it can become dangerous if left untreated. Regular monitoring and early surgical excision are essential to ensure a good prognosis.