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

• Published in: Journal of the American Academy of Dermatology Vol. 58; no. 1; pp. 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: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 2008; Elsevier
• 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; Stag; Skin disease; Premalignant lesion; Pigmentation disorder; Excision; Dermatology; Malignant tumor; Dubreuilh precancerous melanosis; Retrospective; Vertebrata; Mammalia; Malignant melanoma; Artiodactyla; Ungulata; Cancer
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2007.09.023

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.