II. Epidemiology

  1. Onset over age 30-40 years
  2. Most common in Caucasian skin (also seen in asians)

III. Pathophysiology

  1. Proliferation of basal Melanocytes, increasing melanization in response to Sun Exposure
  2. Contrast with Freckles which are a result of increased Melanin production

IV. Signs

  1. Characteristics
    1. Small Macules 1-3 cm (up to 5 cm), well circumscribed
    2. Light yellow to light brown to dark brown in color (may be variegated)
    3. Round or oval with slightly irregular border
  2. Distribution: Chronically sun exposed areas
    1. Forehead
    2. Cheeks
    3. Nose
    4. Hand and Forearm dorsum
    5. Upper back
    6. Chest
    7. Shins

V. Differential Diagnosis

  1. Hyperkeratotic lesions (distinguish from the smooth flat surface of Lentigo)
    1. Flat Seborrheic Keratosis
    2. Pigmented Actinic Keratosis
  2. Lentigo maligna (biopsy if suspected)
  3. Ephelides (Freckles)
  4. Cafe Au Lait Macules
  5. Syndrome with multiple Lentigines
    1. Peutz-Jeghers Syndrome
    2. LEOPARD Syndrome
    3. LAMB Syndrome

VI. Red Flags (suggesting biopsy)

  1. Rapid growth
  2. Lesions suspicious for Melanoma
  3. Symptomatic lesions
    1. Pain
    2. Recurrent bleeding
    3. Poor healing

VII. Management

  1. Light Cryotherapy (<5 seconds) with Liquid Nitrogen
    1. Risk of Hyperpigmentation
    2. Lesion will disappear for 1 to 3 years
  2. Combination Therapy (effective)
    1. Tri-luma (Hydroquinone 2%, Tretinoin 0.05%, Flucinolone 0.01%)
    2. Consider combining with light Cryotherapy
  3. Chemical Peel (recurrence is common)
    1. Trichloroacetic acid (Trichlor) 30-35%
  4. Laser therapy (ND:YAG Laser)
    1. Risk of Postinflammatory Hyperpigmentation
  5. Bleaching with Hydroquinone (Eldoquin Forte) 3-4%
    1. May result in blotchy Hyperpigmentation (ochronosis) and may take months to see result
    2. Also risk of acne-type eruption and Hypersensitivity Reaction
  6. Mequinol 2%/Tretinoin 0.01% (Solage) topical solution
  7. Keratolytics (less evidence than with other methods)
    1. Tretinoin (Retin A) 0.025 to 0.05%
    2. Tazarotene (Tazorac) 0.1% cream
    3. Adapalene (Differin) 0.1-0.3% gel

VIII. Prevention

  1. Regular use of Sunscreen (esp. fair skin types 1-3)
  2. Avoid Sunburns before the age of 20 years old

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Ontology: Lentigo (C0023321)

Definition (NCI) A flat, benign, pigmented spot on the skin caused by excessive deposition of melanin from an increased number of melanocytes in the cell layer directly above the basement membrane of the epidermis. Formation is usually related to sun exposure during youth, and the lesions do not typically progress to malignancy.
Definition (MSH) Small circumscribed melanoses resembling, but differing histologically from, freckles. The concept includes senile lentigo ('liver spots') and nevoid lentigo (nevus spilus, lentigo simplex) and may also occur in association with multiple congenital defects or congenital syndromes (e.g., Peutz-Jeghers syndrome).
Concepts Disease or Syndrome (T047)
MSH D007911
ICD10 L81.4
SnomedCT 75534002, 156438005, 267870007, 201286007, 398744007, 402624000
English Lentigos, Lentiginosis, Lentiginoses, Lentigo, LENTIGINES, lentigo (diagnosis), lentigo, Lentigo [Disease/Finding], lentigos, lentiginosis, Lentigines, Lentiginosis (disorder), Lentigo (disorder), Lentigo, NOS
Swedish Lentigo
Japanese ホクロ, コクシ, ほくろ, 黒子, ほくろ症, 黒子症
Czech lentigo, Piha
Finnish Lentigo
Russian LENTIKULIARNYI MELANOZ GENERALIZOVANNYI, LENTIGO, LENTIGINOZ, ЛЕНТИГИНОЗ, ЛЕНТИГО, ЛЕНТИКУЛЯРНЫЙ МЕЛАНОЗ ГЕНЕРАЛИЗОВАННЫЙ
Italian Efelide, Lentiggine, Lentigginosi, Lentigo
Croatian LENTIGINOZA, LENTIGO
Polish Plamy soczewicowate
Hungarian Lentigo
Spanish léntigo, léntigo (trastorno), lentiginosis (trastorno), lentiginosis, lentigo (trastorno), lentigo, Lentigo, Lentiginosis
Norwegian Lentigo
Dutch lentigo, Lentiginosis, Lentigo
German Lentiginose, Lentigo
Portuguese Lentigo, Lentiginose
French Lentiginose, Lentigo, Grain de beauté, Lentigine