Abstract
The melanotic freckle of Hutchinson is a distinct histopathologic and clinical entity that is not confined to the facial skin of the elderly. The microscopic features consist of a diffuse junctional change, including atypical and vacuolated melanocytes arranged in theques and in a single layer. Melanogenesis is variable but normally intense. There is a characteristic underlying lymphocytic infiltrate in the dermis. The development of a malignant melanoma is demonstrated by dermal invasion of the pleomorphic melanocytes. Eighty-five cases from die records of the Armed Forces Institute of Pathology are presented. Malignant melanoma was demonstrated in 45 of these cases and metastasis occurred in four cases. A review of the world literature is presented and the reasons for the failure of this lesion to occupy its rightful place in the oncologic literature are expressed. The authors conclude that the melanotic freckle of Hutchinson is an obligate precancerous lesion with a possible eventual outcome of malignant melanoma. This malignant melanoma has a better prognosis than the malignant melanoma arising de novo or from a junctional nevus. For this reason future series of malignant melanomas should place in a separate category those found to arise in a melanotic freckle in order that a more accurate assessment of prognosis may be made.
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