Staged excision for lentigo maligna and lentigo maligna melanoma: A retrospective analysis of 117 cases

Background Complete surgical excision for lentigo maligna (LM) and LM melanoma (LMM) in the head and neck region may be challenging because of potential significant subclinical extension. Objective We sought to review clinical and histologic features of LM and LMM and determine surgical margin neces...

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Bibliographic Details
Published in:Journal of the American Academy of Dermatology 2008, Vol.58 (1), p.142-148
Main Authors: Hazan, Carole, MD, Dusza, Stephen W., MPH, Delgado, Ruby, MD, Busam, Klaus J., MD, Halpern, Allan C., MD, Nehal, Kishwer S., MD
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Biological and medical sciences
Dermatology
Female
Head and Neck Neoplasms - pathology
Head and Neck Neoplasms - surgery
Humans
Hutchinson's Melanotic Freckle - pathology
Hutchinson's Melanotic Freckle - surgery
Male
Medical sciences
Melanoma - pathology
Melanoma - surgery
Middle Aged
Neoplasm Invasiveness
Neoplasms, Multiple Primary - pathology
Neoplasms, Multiple Primary - surgery
Pigmentary diseases of the skin
Retrospective Studies
Skin Neoplasms - pathology
Skin Neoplasms - surgery
Surgical Procedures, Operative - methods
Tumors of the skin and soft tissue. Premalignant lesions
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Summary:Background Complete surgical excision for lentigo maligna (LM) and LM melanoma (LMM) in the head and neck region may be challenging because of potential significant subclinical extension. Objective We sought to review clinical and histologic features of LM and LMM and determine surgical margin necessary for complete excision. Methods We conducted a retrospective study of 117 LM and LMM cases treated with a staged margin-controlled excision technique with rush paraffin-embedded sections. Results The mean total surgical margin required for excision of LM was 7.1 mm and was 10.3 mm for LMM. Of the tumors diagnosed as LM on initial biopsy specimen, 16% were found to have unsuspected invasion. Total surgical margin was associated with initial clinical lesion diameter. Limitations Retrospective and single-institution experience are limitations. Conclusion This study corroborates that the standard excision margins for LM and LMM are often inadequate and occult invasive melanoma occurs in LM. An excision technique with permanent sections using a team of dermatopathology and surgery that carefully examines the central tumor and the surgical margins is reliable for the treatment of LM and LMM.
ISSN:0190-9622
1097-6787
DOI:10.1016/j.jaad.2007.09.023