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Carmona-Rocha E, Rusiñol L, García-Melendo C, Iznardo H, Mozos A, López-Sánchez C, Yélamos O. Lentigo maligna: a comprehensive review on diagnosis and treatment. Ital J Dermatol Venerol 2024; 159:390-411. [PMID: 39069838 DOI: 10.23736/s2784-8671.24.07837-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Lentigo maligna (LM), a form of melanoma in situ, and LM melanoma (LMM), its invasive counterpart, exhibit distinctive epidemiology, risk factors, and clinical features compared to other melanoma subtypes. Notably, LM occurs on chronically sun-damaged skin presenting as a slow-growing, ill-defined patch which makes it difficult to diagnose and to treat. Additionally, while LM generally presents a favourable prognosis, it can also lead to dermal invasion and behave similarly to other melanomas with the same Breslow thickness. Hence, surgery continues to be the cornerstone treatment. Wide excisions are often necessary, but challenges arise when these lesions manifest in cosmetically sensitive regions, limiting the feasibility and desirability of large excisions. Specialized approaches, including margin-controlled surgery and image-guided treatment with reflectance confocal microscopy, have been developed to address these issues. Other non-surgical treatments such as cryosurgery, imiquimod, radiotherapy, or photodynamic therapy, may also be used but commonly present with recurrent/persistent disease. Herein we comprehensively review the existing literature on the management of LM/LMM, and discus the potential new advances on managing this challenging skin cancer.
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Affiliation(s)
- Elena Carmona-Rocha
- Dermatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut de Recerca Sant Pau (IR Sant Pau), Barcelona, Spain
- Autonomous University of Barcelona, Bellaterra, Spain
| | - Lluís Rusiñol
- Dermatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut de Recerca Sant Pau (IR Sant Pau), Barcelona, Spain
- Autonomous University of Barcelona, Bellaterra, Spain
- Dermatology Department, Teknon Quirónsalud Medical Center, Barcelona, Spain
| | | | - Helena Iznardo
- Dermatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut de Recerca Sant Pau (IR Sant Pau), Barcelona, Spain
- Autonomous University of Barcelona, Bellaterra, Spain
| | - Anna Mozos
- Anatomical Pathology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Cristina López-Sánchez
- Dermatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut de Recerca Sant Pau (IR Sant Pau), Barcelona, Spain
- Autonomous University of Barcelona, Bellaterra, Spain
- Dermatology Department, Teknon Quirónsalud Medical Center, Barcelona, Spain
| | - Oriol Yélamos
- Dermatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain -
- Institut de Recerca Sant Pau (IR Sant Pau), Barcelona, Spain
- Autonomous University of Barcelona, Bellaterra, Spain
- Dermatology Department, Teknon Quirónsalud Medical Center, Barcelona, Spain
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2
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Chen Q, Zheng M, Ling C. Incidence trends of lentigo maligna and lentigo maligna melanoma in the United States from 2000 to 2019. Int J Dermatol 2024; 63:647-654. [PMID: 38173361 DOI: 10.1111/ijd.16982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 10/27/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Information on lentigo maligna (LM) and lentigo maligna melanoma (LMM) in the 21st century is scarce. We aimed to elucidate the incidence of LM and LMM using the Surveillance, Epidemiology, and End Results (SEER) 17 Registries. METHODS The data of patients diagnosed between 2000 and 2019 were extracted from the SEER database. The percentage of LM/LMM cases among all melanoma patients, age-standardized incidence rates, estimated annual percentage changes, and the cumulative incidence of LMM after LM were calculated. RESULTS The SEER data yielded 95,175 patients with LM/LMM between 2000 and 2019. Cases of LM/LMM accounted for 15.7% of all melanomas. The age-standardized incidence per 100,000 person-years for LM increased from 4.16 to 5.61 and for LMM from 1.33 to 2.35 between 2000 and 2019. The annual increase in incidence of LM was 2.42%, and that of LMM was 3.32%. The cumulative incidence of LMM after a primary LM after 10-year follow-up was 0.94%. CONCLUSIONS This study provides the first comprehensive analysis of the epidemiological status of LM/LMM in the United States in the 21st century using the population-based SEER data.
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Affiliation(s)
- Qiong Chen
- Department of Dermatology, Wenzhou TCM Hospital of Zhejiang Chinese Medical University, Wenzhou, China
| | - Mingjing Zheng
- Department of Dermatology, Wenzhou TCM Hospital of Zhejiang Chinese Medical University, Wenzhou, China
| | - Caicai Ling
- Department of Dermatology, Wenzhou TCM Hospital of Zhejiang Chinese Medical University, Wenzhou, China
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3
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Karponis D, Stratigos IA, Joshy J, Craig PJ, Mistry K, van Bodegraven B, Venables ZC, Levell NJ. Lentigo maligna: a review. Clin Exp Dermatol 2024; 49:218-225. [PMID: 37966718 DOI: 10.1093/ced/llad394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/19/2023] [Accepted: 11/07/2023] [Indexed: 11/16/2023]
Abstract
Lentigo maligna (LM) is a melanoma in situ with distinct clinical features and histology. It commonly affects men after the sixth decade of life. Incidence rates of LM have increased based on early 21st century data from different countries; however, data are suboptimal. Data from England show a plateauing crude incidence between 2013 and 2019. By comparison, invasive melanoma and other types of melanoma in situ commonly appears in younger age groups (median age 58 and 67 years old, respectively) and incidence is rising. The most important risk factors for LM include fair skin and cumulative ultraviolet solar radiation exposure. Although LM is limited to the epidermis and connected skin adnexa, it may progress to invasive LM melanoma. The reported rate of malignant progression varies, reflecting a challenge for LM epidemiology research as often lesions are removed on diagnosis. LM poses a challenge in diagnosis and management. Although it can be diagnosed clinically or dermoscopically, histopathological assessment of biopsied skin tissue remains the gold standard. Reflectance confocal microscopy allows for better appreciation of the complexity of LM at a cellular level, often progressing beyond clinical margins. Management of LM may involve Mohs micrographic surgery or excision, although recurrence may occur even with 5 mm clinical margins. Imiquimod cream may be effective, but incomplete treatment and recurrence has been reported. Conservative management with observation or radiotherapy may be used in selected patients' cases. Five-year net survival rates are excellent. This paper reviews the natural history, epidemiology, aetiology, pathogenesis, diagnosis and management of LM.
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Affiliation(s)
- Dimitrios Karponis
- Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, UK
| | | | - Jilse Joshy
- Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Paul J Craig
- Cellular Pathology, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Khaylen Mistry
- Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Birgitta van Bodegraven
- British Association of Dermatologists, London, UK
- National Disease Registration Service, Data and Analytics, NHS England, UK
| | - Zoe C Venables
- Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
- National Disease Registration Service, Data and Analytics, NHS England, UK
| | - Nick J Levell
- Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
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4
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Huang C, Burke H, Scolyer RA, Guitera P. Lentigo maligna and lentigo maligna melanoma in young patients in Australian tertiary centres. Clin Exp Dermatol 2023; 48:799-800. [PMID: 36916530 DOI: 10.1093/ced/llad089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 03/22/2023] [Indexed: 03/15/2023]
Abstract
This was a retrospective study of all patients with a diagnosis of lentigo maligna or lentigo maligna melanoma at 50 years of age or younger at the time of their first diagnosis in two Australian tertiary centres. The low recurrence rate in younger patients in this study warrants further investigation. Early diagnosis in young patients is crucial to allow early treatment and lifestyle changes to reduce actinic damage and subsequent development of further melanomas.
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Affiliation(s)
- Cheng Huang
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Melanoma Institute Australia
| | | | - Richard A Scolyer
- Melanoma Institute Australia
- Faculty of Medicine and Health
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Pascale Guitera
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Melanoma Institute Australia
- Faculty of Medicine and Health
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5
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Gouveia BM, Carlos G, Wadell A, Sinz C, Ahmed T, Lo SN, Rawson RV, Ferguson PM, Scolyer RA, Guitera P. In vivo reflectance confocal microscopy can detect the invasive component of lentigo maligna melanoma: Prospective analysis and case-control study. J Eur Acad Dermatol Venereol 2023; 37:1293-1301. [PMID: 36855833 PMCID: PMC10946995 DOI: 10.1111/jdv.18998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 02/08/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Lentigo maligna (LM), a form of melanoma in situ, has no risk of causing metastasis unless dermal invasive melanoma (LMM) supervenes. Furthermore, the detection of invasion impacts prognosis and management. OBJECTIVE To assess the accuracy of RCM for the detection of invasion component on LM/LMM lesions. METHODS In the initial case-control study, the performance of one expert in detecting LMM at the time of initial RCM assessment of LM/LMM lesions was recorded prospectively (n = 229). The cases were assessed on RCM-histopathology correlation sessions and a panel with nine RCM features was proposed to identify LMM, which was subsequently tested in a subset of initial cohort (n = 93) in the matched case-control study by two blinded observers. Univariable and multivariable logistic regression models were performed to evaluate RCM features predictive of LMM. Reproducibility of assessment of the nine RCM features was also evaluated. RESULTS A total of 229 LM/LMM cases evaluated by histopathology were assessed blindly and prospectively by an expert confocalist. On histopathology, 210 were LM and 19 were LMM cases. Correct identification of an invasive component was achieved for 17 of 19 LMM cases (89%) and the absence of a dermal component was correctly diagnosed in 190 of 210 LM cases (90%). In the matched case-control (LMM n = 35, LM n = 58), epidermal and junctional disarray, large size of melanocytes and nests of melanocytes were independent predictors of LMM on multivariate analysis. The interobserver analysis demonstrated that these three features had a fair reproducibility between the two investigators (K = 0.4). The multivariable model including those three features showed a high predictive performance AUC = 74% (CI 95% 64-85%), with sensitivity of 63% (95% CI 52-78%) and specificity of 79% (CI 95% 74-88%), and likelihood ratio of 18 (p-value 0.0026). CONCLUSION Three RCM features were predictive for identifying invasive melanoma in the background of LM.
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Grants
- Melanoma Institute Australia
- N/A MetaOptima Technology Incl., Hoffmann-La Roche Ltd, Evaxion, Provectus Biopharmaceuticals Australia, Qbiotics, Novartis, Merck Sharp & Dohme, NeraCare, AMGEN Inc., Bristol-Myers Squibb, Myriad Genetics, GlaxoSmithKline.
- APP1141295 NHMRC Practitioner Fellowship
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Affiliation(s)
- Bruna Melhoranse Gouveia
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Giuliana Carlos
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Andreanne Wadell
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- CHUS - Hôtel-Dieu, Sherbrooke, Québec, Canada
| | - Christoph Sinz
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Tasnia Ahmed
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Robert V Rawson
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, New South Wales, Australia
| | - Peter M Ferguson
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, New South Wales, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Pascale Guitera
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Martinez-Molina M, Richarz N, Jaka A, Bassas-Vila J, Mora-Fernández V, Pi-Sunyer AQ, Podlipnik S, Carrascosa JM, Boada A. Spaghetti Technique Versus Wide Local Excision for Lentigo Maligna Affecting the Head and Neck Regions: Surgical Outcome and Descriptive Analysis of 79 Cases from a Single Practice Cohort. Dermatol Pract Concept 2023; 13:e2023193. [PMID: 37557139 PMCID: PMC10412079 DOI: 10.5826/dpc.1303a193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Lentigo maligna is a subtype of melanoma in situ that typically affects the head and neck region with an increasing incidence. Margin-controlled techniques, such as spaghetti technique (ST), have gained popularity over wide local excision (WLE) with a margin of 5 mm. OBJECTIVES To evaluate the outcomes of lentigo maligna cases in the head and neck area treated by either WLE or ST in a tertiary referral hospital. The secondary goal was to describe the demographic and clinical characteristics of our series. METHODS Cohort study of patients diagnosed with lentigo maligna on the head and neck region between January 2014 and February 2022 in a tertiary hospital. RESULTS In total, 79 lentigo maligna were studied, corresponding to 77 patients. Fifty-three lesions (67%) were treated with WLE and 26 (33%) with ST. The mean age of the patients was 73 years and 58% were men. Most of the tumors were located on the cheek (50%) and mean lesion diameter was 2.2 cm for the ST group and 1.2 cm for the WLE group. Mean duration follow-up was 44 months. There were two local recurrences in the WLE group (2/53; 3.7%) and none in the ST group. CONCLUSIONS Both WLE and ST are appropriate surgical approaches for lentigo maligna. ST offers an efficient alternative to Mohs surgery for treating lentigo maligna in the head and neck area, especially when guided by reflectance confocal microscopy.
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Affiliation(s)
- Manel Martinez-Molina
- Department of Dermatology, Hospital University Germans Trias i Pujol, Badalona. Autonomous University of Barcelona, Barcelona, Spain
| | - Nina Richarz
- Department of Dermatology, Hospital University Germans Trias i Pujol, Badalona. Autonomous University of Barcelona, Barcelona, Spain
| | - Ane Jaka
- Department of Dermatology, Hospital University Germans Trias i Pujol, Badalona. Autonomous University of Barcelona, Barcelona, Spain
| | - Juli Bassas-Vila
- Department of Dermatology, Hospital University Germans Trias i Pujol, Badalona. Autonomous University of Barcelona, Barcelona, Spain
| | - Verónica Mora-Fernández
- Department of Dermatology, Hospital University Germans Trias i Pujol, Badalona. Autonomous University of Barcelona, Barcelona, Spain
| | - Ariadna Quer Pi-Sunyer
- Department of Pathology, Hospital University Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Sebastian Podlipnik
- Department of Dermatology, Melanoma Unit, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - José Manuel Carrascosa
- Department of Dermatology, Hospital University Germans Trias i Pujol, Badalona. Autonomous University of Barcelona, Barcelona, Spain
| | - Aram Boada
- Department of Dermatology, Hospital University Germans Trias i Pujol, Badalona. Autonomous University of Barcelona, Barcelona, Spain
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7
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Zoutendijk J, Koljenovic S, Wakkee M, Mooyaart A, Nijsten T, van den Bos R. Clinical findings are not helpful in detecting lentigo maligna melanoma in patients with biopsy-proven lentigo maligna. J Eur Acad Dermatol Venereol 2022; 36:2325-2330. [PMID: 35730990 PMCID: PMC9796129 DOI: 10.1111/jdv.18346] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/29/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Lentigo maligna (LM) based on biopsy material might be lentigo maligna melanoma (LMM) after excision. OBJECTIVES Investigate whether clinical and dermoscopic mapping increases the detection rate of LMM when investigating staged excision specimens of biopsy proven LM. METHODS Patients with biopsy-proven LM planned for staged excision were included. Using clinical inspection and dermoscopy, spots suspicious for LMM were marked. After the excision, needles were placed at the marked spots. Histological examination using vertical sections was done at the needles followed by the standard amount of vertical sections. RESULTS In 28 of the 58 biopsy-proven LM, there was clinical suspicion of LMM, only 3 of these 28 cases were upgraded into LMM. These three cases showed LMM in other sections, whereas only 1 case showed LMM around the needle. Within the group without clinical suspicion of LMM, 2 cases were LMM. Biopsy-proven LM were in fact LMM in 8.6% of the cases and were found without the clinical guidance of the dermatologist. CONCLUSIONS 8.6% of the biopsy-proven LM were LMM after complete histological examination. In this study, the dermatologist was not able to increase the detection rate of LMM by using clinical and dermoscopic mapping.
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Affiliation(s)
- J. Zoutendijk
- Department of Dermatology, Erasmus MC Cancer InstituteUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - S. Koljenovic
- Department of PathologyErasmus MC University Medical CenterRotterdamThe Netherlands,Department of PathologyAntwerp University HospitalAntwerpBelgium
| | - M. Wakkee
- Department of Dermatology, Erasmus MC Cancer InstituteUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - A.L. Mooyaart
- Department of PathologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | - T. Nijsten
- Department of Dermatology, Erasmus MC Cancer InstituteUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - R.R. van den Bos
- Department of Dermatology, Erasmus MC Cancer InstituteUniversity Medical Center RotterdamRotterdamThe Netherlands
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Regio Pereira A, Guitera P, Ferguson PM, Ch'ng S, Hirata S. Complex melanoma of the scalp: Diagnosis and management aided by confocal microscopy. Australas J Dermatol 2021; 63:105-109. [PMID: 34699066 DOI: 10.1111/ajd.13735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/05/2021] [Indexed: 11/27/2022]
Abstract
Melanomas of lentigo maligna subtype are a steadily growing problem and frequently represent a clinical challenge. A case is reported of a complex melanoma of the scalp illustrating the critical role of confocal microscopy for optimal diagnosis and management.
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Affiliation(s)
- Amanda Regio Pereira
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, Australia.,Federal University of Sao Paulo, Sao Paulo, Brazil.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Pascale Guitera
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Melanoma Institute Australia, Sydney, Australia
| | - Peter M Ferguson
- Melanoma Institute Australia, Sydney, Australia.,Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, Australia
| | - Sydney Ch'ng
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Melanoma Institute Australia, Sydney, Australia
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Guitera P, Waddell A, Paton E, Fogarty GB, Hong A, Scolyer RA, Stretch JR, O'Donnell BA, Pellacani G. A practical guide on the use of imiquimod cream to treat lentigo maligna. Australas J Dermatol 2021; 62:478-485. [PMID: 34529272 DOI: 10.1111/ajd.13720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 08/23/2021] [Accepted: 08/27/2021] [Indexed: 11/29/2022]
Abstract
Lentigo maligna (LM) is a common in situ melanoma subtype arising on chronically sun-damaged skin and mostly affects the head and neck region. Localisation in cosmetically sensitive areas, difficulty to obtain wide resection margins and advanced patient age/comorbidities have encouraged investigation of less invasive therapeutic strategies than surgery in managing complex cases of LM. Radiotherapy and imiquimod have emerged as alternative treatment options in this context. The treatment of LM with imiquimod cream can be challenging due to the nature of the disease including its often large size, variegated appearance, involvement of adnexal structures, poorly defined peripheral edge and frequent localisation close to sensitive structures such as the eyes and lips, and elderly patients with multiple comorbidities. Prolonged and unpredictable inflammatory reaction and side effects and compliance with a patient-delivered therapy can also be challenging. In the literature to date, studies evaluating the use of imiquimod to treat LM have utilised varying methodologies and provided short follow-up and these limitations have impaired the development of clear guidelines for dosage and management of side effects. Based on our multidisciplinary experience and review of the literature, we propose practical clinical strategies for the use of imiquimod for treating LM, detailing optimal administration procedures in various clinical scenarios and long-term management, with the aim of facilitating optimal patient outcomes.
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Affiliation(s)
- Pascale Guitera
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Australia
| | - Andreanne Waddell
- Department of Medicine/Division of Dermatology, Universite de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Elizabeth Paton
- Melanoma and Skin Cancer Trials (MASC Trials), Monash University, Australia
| | - Gerald B Fogarty
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Australia.,Genesis Cancer Care, NSW, Australia
| | - Angela Hong
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Australia.,Genesis Cancer Care, NSW, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Australia.,Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, Australia
| | - Jonathan R Stretch
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Australia
| | - Brett A O'Donnell
- Departments of Ophthalmology, Royal North Shore Hospital, Sydney, Australia
| | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
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10
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Laskar R, Ferreiro-Iglesias A, Bishop DT, Iles MM, Kanetsky PA, Armstrong BK, Law MH, Goldstein AM, Aitken JF, Giles GG, Cust AE. Risk factors for melanoma by anatomical site: an evaluation of aetiological heterogeneity. Br J Dermatol 2021; 184:1085-1093. [PMID: 33270213 PMCID: PMC9969114 DOI: 10.1111/bjd.19705] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Melanoma aetiology has been proposed to have two pathways, which are determined by naevi and type of sun exposure and related to the anatomical site where melanoma develops. OBJECTIVES We examined associations with melanoma by anatomical site for a comprehensive set of risk factors including pigmentary and naevus phenotypes, ultraviolet radiation exposure and polygenic risk. METHODS We analysed harmonized data from 2617 people with incident first invasive melanoma and 975 healthy controls recruited through two population-based case-control studies in Australia and the UK. Questionnaire data were collected by interview using a single protocol, and pathway-specific polygenic risk scores were derived from DNA samples. We estimated adjusted odds ratios using unconditional logistic regression that compared melanoma cases at each anatomical site with all controls. RESULTS When cases were compared with control participants, there were stronger associations for many naevi vs. no naevi for melanomas on the trunk, and upper and lower limbs than on the head and neck (P-heterogeneity < 0·001). Very fair skin (vs. olive/brown skin) was more weakly related to melanoma on the trunk than to melanomas at other sites (P-heterogeneity = 0·04). There was no significant difference by anatomical site for polygenic risk. Increased weekday sun exposure was positively associated with melanoma on the head and neck but not on other sites. CONCLUSIONS We found evidence of aetiological heterogeneity for melanoma, supporting the dual pathway hypothesis. These findings enhance understanding of risk factors for melanoma and can guide prevention and skin examination education and practices.
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Affiliation(s)
- Ruhina Laskar
- International Agency for Research on Cancer, Lyon, France
| | | | - D Timothy Bishop
- Leeds Institute of Haematology and Immunology, University of Leeds, Leeds, UK
| | - Mark M Iles
- Division of Haematology and Immunology, Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, UK
- Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
| | - Peter A Kanetsky
- Cancer Epidemiology Program, Moffitt Cancer Center, Tampa, FL, USA
| | - Bruce K Armstrong
- Cancer Epidemiology and Prevention Research Group, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Matthew H Law
- Statistical Genetics, QIMR Berghofer Medical Research Institute, Brisbane, Australia
- Queensland University of Technology (QUT), Brisbane, Australia
| | - Alisa M Goldstein
- Human Genetics Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Joanne F Aitken
- Viertel Centre for Research in Cancer Control, the Cancer Council Queensland, Brisbane, Australia
| | - Graham G Giles
- Cancer Epidemiology Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria 3004, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | | | | | | | - Anne E Cust
- International Agency for Research on Cancer, Lyon, France
- Cancer Epidemiology and Prevention Research Group, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- The Melanoma Institute Australia, The University of Sydney, Sydney, Australia
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Collgros H, Rodriguez-Lomba E, Regio Pereira A, Lo SN, Scolyer RA, Guitera P. Lentiginous melanoma (lentigo maligna and lentigo maligna melanoma) in Australia: clinicopathological characteristics, management and recurrence rates after 10-year follow-up at a tertiary centre. J Eur Acad Dermatol Venereol 2021; 35:1315-1322. [PMID: 33502077 DOI: 10.1111/jdv.17135] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 01/14/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Lentiginous melanoma or lentigo maligna is a slow-growing type of melanoma frequently arising in sun-damaged skin and often first diagnosed in the elderly. Few studies report long-term follow-up. OBJECTIVES To define characteristics of lentiginous melanoma in situ (LM) and invasive lentiginous melanoma (LMM) in Australian patients managed at a tertiary centre and describe local recurrence or treatment failure rates after long-term follow-up. METHODS Retrospective single-centre study of LM/LMM patients evaluated between January 2005 and March 2007. Medical and photographic records were reviewed. RESULTS One hundred two patients were included, with a total of 117 lesions (70 LM and 47 LMM). Seventy-nine were new primary LM/LMM, and 38 were recurrences. Primary cases were mostly pigmented (71%), while 77% of recurrent cases were partially pigmented/light brown or amelanotic. The margins were clinically ill-defined in the majority of cases (64% of primary cases and 94% of recurrent cases). Dermoscopy of the primary LM/LMM showed either classic 'common' melanoma features (33%) or classic LM/LMM features (41%), while 95% of recurrent cases had no features for melanoma or LM/LMM. Primary cases that were initially excised (113, 97%) had mean histopathological clear margins of 4.9 mm (range 0.1-22 mm). The median follow-up time was 7.5 years (95% CI 5.2-10.0) with more than 10-year follow-up in 32% and 5-10 years in 24% of patients. There were 44 (38%) recurrences over the entire follow-up period. Half of the patients who recurred did so within the first 3.8 years after the first treatment. CONCLUSION LM/LMM often recur late and are clinically subtle; therefore, careful monitoring and long-term follow-up are required.
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Affiliation(s)
- H Collgros
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Discipline of Dermatology, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - E Rodriguez-Lomba
- Dermatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - A Regio Pereira
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Discipline of Dermatology, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia.,Federal University of Sao Paulo, Sao Paulo, Brazil
| | - S N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - R A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and New South Wales Health Pathology, Sydney, NSW, Australia.,Central Clinical School, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - P Guitera
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Discipline of Dermatology, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
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12
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Iznardo H, Garcia-Melendo C, Yélamos O. Lentigo Maligna: Clinical Presentation and Appropriate Management. Clin Cosmet Investig Dermatol 2020; 13:837-855. [PMID: 33223843 PMCID: PMC7671473 DOI: 10.2147/ccid.s224738] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/15/2020] [Indexed: 01/12/2023]
Abstract
Lentigo maligna (LM) is a type of melanoma in situ that has distinctive characteristics regarding epidemiology, risk factors and clinical features. In addition, LM has a potential to progress to an invasive tumor with potentially aggressive behavior: lentigo maligna melanoma (LMM). Overall, LM has a very good prognosis, whereas LMM has the same prognosis as other invasive melanomas with similar Breslow thickness. LM/LMM represents a challenging entity not only regarding the diagnosis but also regarding the management. Diagnostic criteria are not well established, and there is an overlap of clinical, dermoscopic and pathological features with other benign pigmented skin lesions such as lentigines, pigmented actinic keratoses or macular seborrheic keratoses. LM/LMM's common appearance within photodamaged skin makes lesion border identification difficult. Wide excisions are often required, but since LM/LMM typically appears on cosmetically sensitive areas such as the face, sometimes large excisions are not possible nor desirable. In this sense, specialized approaches have been developed such as margin-controlled surgery or image-guided treatment using reflectance confocal microscopy. Other treatments for LM such as cryosurgery, imiquimod, radiotherapy or photodynamic therapy have been proposed, although recurrence/persistence is common. The current manuscript reviews extensively the published data regarding the diagnosis, treatment and management of both complex entities LM and LMM.
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Affiliation(s)
- Helena Iznardo
- Dermatology Service, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Garcia-Melendo
- Dermatology Service, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Oriol Yélamos
- Dermatology Service, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Dermatology Service, Centro Médico Teknon - Quirónsalud, Barcelona, Spain
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13
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Pereira AR, Collgros H, Guitera P, Benati E, Longo C, Argenziano G, Dika E, Lambertini M, Menzies SW, Lobato Williams A, Gallo BM, Hirata SH. Melanomas of the scalp: is hair coverage preventing early diagnosis? Int J Dermatol 2020; 60:340-346. [PMID: 33128467 DOI: 10.1111/ijd.15283] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/06/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Scalp melanomas are usually thicker and show worse prognosis than other sites and other head and neck melanomas. One hypothesis to explain this aggressive behavior could be diagnosis delay attributed to hair concealment of lesions. METHODS Primary melanomas of the scalp diagnosed over two decades at four reference centers in Australia and Italy were included. Hair coverage and visibility of the lesions were assessed on preoperative photographic documentation by two investigators and correlated with some prognostic factors (Breslow thickness, mitotic rate, and ulceration). Patients records and pathology reports provided clinical and histological data. RESULTS The majority of 113 melanomas included were located on easily visible areas of the scalp - hairless scalp (49%) or hairline (15%). The remaining ones (36%), considered to be hair-covered, showed more frequently thinning of hair (63%) than a dense hair coverage (37%). Melanomas of "hairy scalps" were more frequently invasive (81%) and had higher median Breslow (0.8 ± 1.3 mm) than those arising on bald scalps or areas with thinning of hair (43%; 0 ± 0.6 mm), P = 0.004. However, when considering only the invasive cases (n = 55), Breslow thickness and mitotic rate were not statistically different between concealed and easily visible areas. Melanomas detected by a doctor were thinner than those first noticed by the patient, relatives, or a hairdresser (P < 0.001). CONCLUSIONS Most scalp melanomas arose on easily visible areas, which are more prone to ultraviolet damage. Hair-covered ones, despite rare, could be overlooked during examination. Proactive screening of the scalp area should be encouraged.
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Affiliation(s)
- Amanda Regio Pereira
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Federal University of Sao Paulo, Sao Paulo, Brazil.,Discipline of Dermatology, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Helena Collgros
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Discipline of Dermatology, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Pascale Guitera
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Discipline of Dermatology, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Melanoma Institute Australia, Sydney, NSW, Australia
| | - Elisa Benati
- Centro oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Caterina Longo
- Centro oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Emi Dika
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Martina Lambertini
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Scott W Menzies
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Discipline of Dermatology, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | | | - Bruna M Gallo
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Melanoma Institute Australia, Sydney, NSW, Australia
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14
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Crouch G, Sinha S, Lo S, Saw RPM, Lee KK, Stretch J, Shannon K, Guitera P, Scolyer RA, Thompson JF, Ch'ng S. Clinical outcomes following surgical treatment of lentigo maligna of the head and neck. Eur J Surg Oncol 2020; 47:1145-1151. [PMID: 33023795 DOI: 10.1016/j.ejso.2020.09.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 09/22/2020] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Lentigo maligna (LM), a subtype of melanoma in-situ commonly occurring in the head and neck region, often presents a treatment challenge due to anatomical constraints, particularly on the face of mostly elderly patients. This study sought to assess the clinical outcomes of wide local excision of head and neck LM, identify predictors of recurrence and define optimal excision margins. MATERIALS AND METHODS Patients with LM treated between January 1997 and December 2012 were identified from the large institutional database of a tertiary center and their data were analyzed. RESULTS In 379 patients, 382 lesions were eligible for analysis. Median maximal lesion diameter was 10.5 mm. The mean surgical excision and histopathological clearance margins were 6.2 mm and 4.0 mm, respectively. Median follow-up was 32 months. The LM recurrence rate was 9.9%, and subsequent invasive melanoma developed in 2.3% of cases (mean Breslow thickness 0.7 mm). The recurrence rate was 27.2% if the histological margin was <3.0 mm (median time to recurrence 46.5 months) compared with 2.6% if the margin was ≥3.0 mm. The mean surgical margin required to achieve a histological clearance of ≥3.0 mm was 6.5 mm. CONCLUSIONS Our data suggest that to minimize recurrence, a histological margin of ≥3.0 mm is required. To achieve this, a surgical margin of ≥6.5 mm was required. This is greater than the 5 mm margin recommended in some national guidelines. Careful long-term follow-up is required for all patients because of the risk of recurrence.
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Affiliation(s)
- Gareth Crouch
- Sydney Medical School, The University of Sydney, Sydney, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Shiba Sinha
- Department of Plastic and Reconstructive Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Serigne Lo
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia
| | - Robyn P M Saw
- Sydney Medical School, The University of Sydney, Sydney, Australia; Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Kenneth K Lee
- Department of Plastic and Reconstructive Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Jonathan Stretch
- Sydney Medical School, The University of Sydney, Sydney, Australia; Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Kerwin Shannon
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, Australia; Sydney Head & Neck Cancer Institute, Chris O'Brien Lifehouse Cancer Center, Sydney, Australia
| | - Pascale Guitera
- Sydney Medical School, The University of Sydney, Sydney, Australia; Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia; Sydney Melanoma Diagnostic Center, Royal Prince Alfred Hospital, Sydney, Australia(-)
| | - Richard A Scolyer
- Sydney Medical School, The University of Sydney, Sydney, Australia; Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia; Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, Australia
| | - John F Thompson
- Sydney Medical School, The University of Sydney, Sydney, Australia; Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Sydney Ch'ng
- Sydney Medical School, The University of Sydney, Sydney, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Department of Plastic and Reconstructive Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, Australia.
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15
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Fogarty GB, Hong AM, Rocha L, Vilain RE, Ferguson P, Guitera P. Is more dose and skin reaction required when treating early lentigo maligna definitively with radiotherapy? A case series. ACTA ACUST UNITED AC 2020. [DOI: 10.15406/ijrrt.2020.07.00280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Introduction: Atypical intraepidermal melanocytic proliferation (AIMP) is an early form of lentigo maligna (LM) which itself is a precursor to melanoma. It presents commonly on the head and neck where tissue conserving therapies are attractive. When treating LM with imiquimod, dermatologists treat until a certain level of skin inflammation is achieved. Radiation oncologists treat to a set dose of radiation irrespective of the skin reaction at completion. The dose of radiotherapy for AIMP is unknown and these lesions are currently treated in the same manner as LM. Case series: Five immunocompetent patients (average age 80 years) with AIMP or early LM (ELM) on the head and neck region were treated with RADICAL radiotherapy (RT) protocols. All treatment sites were mapped with in vivo reflectance confocal microscopy (RCM) and measured on average 4.0 cm in diameter (range 2.0–6.0 cm). The median RT dose administered was 50 Gray (Gy) [45-54 Gy] in 1.8-2Gy per fraction to the planning target volume (PTV), usually by megavoltage electrons. All patients completed RT. The peak radiation acute skin toxicity observed at any time in all patients was only dry desquamation, equivalent to a grade 2 acute radiation dermatitis reaction by Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0. At a median of follow up of 10 months, all patients had biopsy proven recurrence of AIMP (n=3) or LM (n=2). All recurrences were within the RT field. Patients were followed for an average total of five years post salvage treatment (range: 26 - 124 months). Discussion: This series raises questions. First, what radiation dose is required to cure AIMP and ELM? This series suggests that the same dose, if not higher, used in established in-situ disease, is required. Second, should radiation oncologists treat to a grade 3 skin reaction? It may be then advisable to use standard fractionation (2Gy or less) so that the peak RT reaction coincides with the end of treatment and allows for titration and extra dose to be added.
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16
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Liu A, Botkin A, Murray C, Solish N, Kitchen J, Chan AW. Outcomes of Staged Excision With Circumferential en Face Margin Control for Lentigo Maligna of the Head and Neck. J Cutan Med Surg 2020; 25:18-24. [PMID: 32911979 DOI: 10.1177/1203475420952425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Treatment practices vary for lentigo maligna (LM). Staged excision with circumferential margin control (SECMC) has the potential to achieve low recurrence rates. OBJECTIVES To evaluate the clinical outcomes of SECMC using permanent, paraffin-embedded sections and delayed reconstruction. METHODS We conducted a retrospective, uncontrolled, observational cohort study involving patients who underwent staged excision for LM of the head and neck at Women's College Hospital in Toronto, Canada, from September 2010 to March 2013. Recurrence and infection rates were ascertained from patient charts and postal surveys. RESULTS One hundred and two patients (45 female, 57 male) were included with a median follow-up time of 1410.5 (IQR 260-1756) days. The median age was 69 (IQR 61-79) years. Approximately one-fifth (21%, 21/102) of patients required greater than 0.5 cm margins to achieve histological clearance. One patient (1/102) upstaged to invasive melanoma based on the initial stage of excision. The infection rate was 6% (6/102) and the 5-year cumulative recurrence rate was 1.4% (95% CI 0.2-9.6%). CONCLUSION SECMC using permanent sections and delayed reconstruction appears to be a safe and effective treatment method for LM on the head and neck. Randomized trials are needed to help define the optimal treatment.
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Affiliation(s)
- Annie Liu
- 8664 Division of Dermatology, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Alexis Botkin
- 7938 Division of Dermatology, University of Toronto, Toronto, ON, Canada
| | - Christian Murray
- 8664 Division of Dermatology, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Nowell Solish
- 8664 Division of Dermatology, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Jessica Kitchen
- 7985 Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - An-Wen Chan
- 8664 Division of Dermatology, Women's College Hospital, University of Toronto, Toronto, ON, Canada
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17
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Marini L, Marini S. Lentigo maligna and intensified ablative fractional laser-assisted PDT: a promising, minimally invasive treatment approach. J Eur Acad Dermatol Venereol 2020; 34:440-441. [PMID: 32112614 DOI: 10.1111/jdv.16262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- L Marini
- The Skin Doctors' Center, Trieste, Italy
| | - S Marini
- Queen's University School of Medicine, Belfast, UK
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