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Mechlin A. Operative Therapie des malignen Melanoms. AKTUELLE DERMATOLOGIE 2022. [DOI: 10.1055/a-1540-1518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ZusammenfassungDie operative Therapie ist maßgeblich im Behandlungskonzept des malignen Melanoms. Sie ist essentieller Bestandteil der Diagnosesicherung, des Stagings und der Therapie in allen Stadien der Erkrankung. Die optimale Planung und Durchführung der Primärexzision, der Sentinel-Lymphknoten-Biopsie und der Nachexzision mit Sicherheitsabstand legen den Grundstein einer erfolgreichen Behandlung, die neben oder auch in Kombination mit einer modernen Systemtherapie die Metastasen-Chirurgie miteinschließt.
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2
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Ahn GS, Pousti B, Singh G, Elsensohn A, Jiang SIB. No Recurrence in Primary Invasive Stage 1a and 1b Melanoma and Melanoma in Situ Treated With Serial Disk Staged Excision. Dermatol Surg 2022; 48:276-282. [PMID: 34935746 DOI: 10.1097/dss.0000000000003357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Optimal surgical treatment modality for invasive melanoma (IM) and melanoma in situ (MIS) has been debated with proponents for standard wide local excision (WLE), serial disk staged excision, and Mohs micrographic surgery. OBJECTIVE The purpose of this study is to identify the recurrence rates and surgical margins of invasive stage 1 melanoma and MIS lesions using serial disk staged excision technique with rush permanent processing and "bread loafing" microscopic analysis. MATERIALS AND METHODS Recurrence rates and surgical margins of 63 IM and 207 MIS at the University of California Dermatology Surgery Unit were retrospectively reviewed. RESULTS No recurrences were observed with average follow-up of 34 and 36 months for IM and MIS, respectively (range, 10-92 months). Average surgical margins were 19.8 mm (SD 9.7) for IM and 12.1 mm (SD 12.2) for MIS. CONCLUSION This SSE technique for the treatment of IM and MIS is comparable in efficacy to other SSE techniques, and it offers physicians a simple and accessible alternative to WLE and MMS.
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Affiliation(s)
- Grace Sora Ahn
- All authors are affiliated with the Department of Dermatology, University of California San Diego, La Jolla, California
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3
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Gaitanis G, Bassukas ID. A Review of Immunocryosurgery and a Practical Guide to Its Applications. Diseases 2021; 9:71. [PMID: 34698134 PMCID: PMC8544578 DOI: 10.3390/diseases9040071] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/25/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022] Open
Abstract
Immunocryosurgery is a minimally invasive combinational therapeutic procedure that has been designed, developed, and evaluated in the Dermatology Department of the University of Ioannina from 2004. In a fixed time protocol, this approach combines immune stimulatory therapy with imiquimod and cryosurgery, i.e., cryosurgery is applied during continuous imiquimod treatment. Laboratory findings in tissue and blood level credit the efficacy to the synergy of imiquimod and cryosurgery. The synergy has been established through clinical trials and the excellent feasibility and efficacy demonstrated in clinical practice. Immunocryosurgery has extensive proof of excellent efficacy, comparable to surgery, in the treatment of basal cell carcinoma. It has also been evaluated in cases of Bowen's disease, keratoacanthoma, Merkel cell carcinoma, lentigo maligna, and cutaneous squamous cell carcinoma with or without the addition of adjuvants. The aims of this review are to detail the immunocryosurgery protocol with the addition of daily practice clinical tips, compile data on the mechanism of action of immunocryosurgery, and delineate indications and possible future applications. Most of the available data originate from the treatment of BCC, of all histological types and localizations, and the principles reported mainly reflect on evidence related to the treatment of this common skin cancer.
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Affiliation(s)
- Georgios Gaitanis
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece;
- Delc Clinique, 2502 Biel/Bienne, Switzerland
| | - Ioannis D. Bassukas
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece;
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Abstract
Lentigo maligna (LM) is a melanocytic neoplasm found on chronically sun-exposed areas of the body, particularly the head and neck. It commonly occurs in the elderly and has been referred to as a "senile freckle." It has also been termed "Hutchinson melanotic freckle," as it was first described by John Hutchinson in 1892. LM is defined as melanoma in situ and thus confined to the epidermis. LM lesions that invade the dermis are termed lentigo maligna melanoma, 1 of the 4 subtypes of malignant melanoma.
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Affiliation(s)
- Jacob D Franke
- Southern Illinois University, School of Medicine, 747 N. Rutledge Street, Springfield, IL 62702, USA
| | - Katlyn M Woolford
- Southern Illinois University, School of Medicine, 747 N. Rutledge Street, Springfield, IL 62702, USA
| | - Michael W Neumeister
- Department of Surgery, The Elvin G Zook Endowed Chair - Institute for Plastic Surgery, Southern Illinois University, 747 N Rutledge Street #3, Springfield, IL 62702, USA.
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5
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Kwak R, Joyce C, Werchniak AE, Lin JY, Tsibris HC. Clinical and histologic features associated with lentigo maligna clearance after imiquimod treatment. J DERMATOL TREAT 2021; 33:1995-1999. [PMID: 34315342 DOI: 10.1080/09546634.2021.1962001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Imiquimod cream may be used as a non-surgical treatment for lentigo maligna or as adjuvant therapy following excision to decrease the risk of recurrence. OBJECTIVES To evaluate histologic and clinical factors associated with clinical clearance of lentigo maligna treated with imiquimod. METHODS We performed a retrospective review of all patients diagnosed with lentigo maligna and treated with imiquimod between 1997 and 2019 at our academic institution. RESULTS We observed clinical clearance in 93% (66/71) of participants who received adjuvant imiquimod following surgery and 79% (19/24) in the primary non-surgical treatment group over a median of 38 months of follow-up. In the adjuvant therapy group, positive surgical margins were associated with a decreased rate of clinical clearance when compared to cases with close (<1 mm) margins or background melanocytic dysplasia (83.3 vs. 100%, p = .01). The presence of an inflammatory response during treatment was associated with increased clearance (94.1 vs. 66.7%, p = .02). CONCLUSIONS Adjuvant imiquimod treatment may decrease LM recurrence rates in cases with background melanocytic dysplasia or close margins. LM cases with positive surgical margins need close clinical follow-up given higher recurrence rates.
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Affiliation(s)
- R Kwak
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - C Joyce
- Department of Public Health Sciences, Loyola University Chicago, Chicago, IL, USA
| | | | - J Y Lin
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - H C Tsibris
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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6
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Naik PP. Diagnosis and Management of Lentigo Maligna: Clinical Presentation and Comprehensive Review. J Skin Cancer 2021; 2021:7178305. [PMID: 34350036 PMCID: PMC8328731 DOI: 10.1155/2021/7178305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/10/2021] [Accepted: 07/21/2021] [Indexed: 11/17/2022] Open
Abstract
Lentigo maligna (LM), also known as Hutchinson's melanotic freckle, is a form of in situ melanoma characterized by the proliferation of atypical melanocytes along the basal epidermis in sun-damaged skin. If left untreated, LM will progress to lentigo maligna melanoma (LMM), a form of invasive melanoma with the same prognosis as other forms of invasive melanoma. LM is more common in the elderly, with a peak occurrence between the ages of 65 and 80 years. LM, however, is rarely present on the trunk and extremities. The diagnosis of LM, confirmed by histopathological and biopsy examination, is based on clinical and dermoscopic features. It typically begins as a tan-brown macule or patch, but it can progress to a variegated pigmentation with dark black color or even amelanotic characteristics. The risk factors involved in the LM development include a history of sunburns, lighter skin types, advanced age, history of nonmelanoma skin cancers, and tendency to form solar lentigines. This article explains the clinical presentation of LM, also reviews the available information on the diagnosis and management of LM, and discusses the potential of such information in facilitating the future prospective.
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Affiliation(s)
- Piyu Parth Naik
- Department of Dermatology, Saudi German Hospitals and Clinics, Hessa Street 331 West, Al Barsha 3, Exit 36 Sheikh Zayed Road, Opposite of American School, Dubai, UAE
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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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8
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Elshot YS, Zupan-Kajcovski B, Klop WMC, Bekkenk MW, Crijns MB, de Rie MA, Balm AJM. Handheld reflectance confocal microscopy: Personalized and accurate presurgical delineation of lentigo maligna (melanoma). Head Neck 2020; 43:895-902. [PMID: 33231342 PMCID: PMC7984324 DOI: 10.1002/hed.26545] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 12/29/2022] Open
Abstract
Background The surgical treatment of lentigo maligna melanoma is associated with high rates of local recurrence. Handheld reflectance confocal microscopy (HH‐RCM) allows for in vivo presurgical detection of subclinical lentigo maligna (melanoma) (LM/LMM). Methods A single‐center retrospective study from December 2015 to July 2017. Frequency and extent of negative surgical margins, and the diagnostic accuracy of presurgical mapping by HH‐RCM was determined. Results Twenty‐six consecutive patients with LM/LMM were included. In 45.8%, HH‐RCM detected subclinical LM with a sensitivity of 0.90 and specificity of 0.86. The management was changed in two (7.7%) patients. Of the 24 remaining lesions, 95.8% were excised with negative margins with a mean histological margin of 3.1 and 5.3 mm for LM and LMM, respectively. At a mean follow‐up of 36.7 months, there was one (4.8%) confirmed recurrence. Conclusions Our method of presurgical delineation by HH‐RCM appears to provide a reliable method for the surgical treatment of LM/LMM with a limited rate of overtreatment.
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Affiliation(s)
- Yannick S Elshot
- Department of Dermatology, The Netherlands Cancer Institute, Amsterdam, the Netherlands.,Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - William M C Klop
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Marcel W Bekkenk
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marianne B Crijns
- Department of Dermatology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Menno A de Rie
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Alfons J M Balm
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, the Netherlands.,Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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9
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Coco V, Perino F, Di Stefani A, Cappilli S, Peris K. Reflectance confocal microscopy and its role in the follow-up of a topical treatment for lentigo maligna. Int J Dermatol 2020; 60:196-200. [PMID: 32710558 DOI: 10.1111/ijd.15070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/07/2020] [Accepted: 06/22/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND In recent years, there has been an ongoing interest in topical treatment for lentigo maligna (LM) as imiquimod 5% cream owing to the localization of this tumor and the advanced age of patients; however, the efficacy of imiquimod 5% cream is controversial, and the rate of local relapses is about 25-53%. Reflectance confocal microscopy (RCM) is a noninvasive diagnostic tool useful not only for diagnostic purpose but also for monitoring the response to the local treatment of LM. Our aim was to demonstrate the role of RCM in the follow-up of a topical treatment with imiquimod 5% cream in clinical practice. METHODS We report three patients with histopathologically confirmed LM who were not candidates for surgery and were successfully treated with imiquimod 5% cream. In such patients, dermatoscopic images and reflectance confocal microscopy were useful to evaluate treatment response and to verify long-term clinical benefits during the follow-up visits. RESULTS No relapses were observed in our patients 18 months after the end of treatment; although, continuous follow-up visits are needed in these patients. CONCLUSIONS In the case series presented herein, we highlight the importance of RCM as a noninvasive tool to monitor the efficacy of imiquimod to treat LM during and after treatment. Detailed confocal images of two of our patients allowed us to establish the persistence of atypical cells and to continue treatment, although clinical and dermatoscopic examinations showed "apparent complete remission" after the first cycle of therapy.
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Affiliation(s)
- Valeria Coco
- Institute of Dermatology, Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Francesca Perino
- Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | | | - Simone Cappilli
- Institute of Dermatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ketty Peris
- Institute of Dermatology, Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
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10
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Shahriari N, Grant-Kels JM, Rabinovitz H, Oliviero M, Scope A. Reflectance confocal microscopy: Principles, basic terminology, clinical indications, limitations, and practical considerations. J Am Acad Dermatol 2020; 84:1-14. [PMID: 32553679 DOI: 10.1016/j.jaad.2020.05.153] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/09/2020] [Accepted: 05/12/2020] [Indexed: 12/24/2022]
Abstract
Reflectance confocal microscopy (RCM) is a noninvasive imaging tool used for in vivo visualization of the skin. It has been extensively studied for use in the evaluation of equivocal cutaneous neoplasms to decrease the number of biopsy procedures in patients with benign lesions. Furthermore, its applications are broadening to include presurgical cancer margin mapping, tumor recurrence surveillance, monitoring of ablative and noninvasive therapies, and stratification of inflammatory disorders. With the approval of category I Current Procedural Terminology reimbursement codes for RCM image acquisition and interpretation, use of this technology has been increasingly adopted by dermatologists. The first article in this 2-part continuing medical education series highlights basic terminology, principles, clinical applications, limitations, and practical considerations in the clinical use of RCM technology.
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Affiliation(s)
- Neda Shahriari
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut.
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut; Department of Dermatology, University of Florida, Gainesville, Florida
| | - Harold Rabinovitz
- Skin and Cancer Associates, Plantation, Florida; Dermatology Department, Medical College of Georgia at Augusta University, Augusta, Georgia
| | | | - Alon Scope
- The Kittner Skin Cancer Screening and Research Institute, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Dermatology Service, Memorial Sloan-Kettering Center, New York, New York
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11
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Sharma AN, Foulad DP, Doan L, Lee PK, Atanaskova Mesinkovska N. Mohs surgery for the treatment of lentigo maligna and lentigo maligna melanoma - a systematic review. J DERMATOL TREAT 2019; 32:157-163. [PMID: 31696746 DOI: 10.1080/09546634.2019.1690624] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The role of Mohs micrographic surgery (MMS) in the treatment of lentigo maligna (LM), and lentigo maligna melanoma (LMM) has been controversial. The use of frozen sections is commonly cited as a suboptimal way to distinguish atypical melanocytes, resulting in traditional wide-local excision techniques as the mainstay of therapy. OBJECTIVE To compare the success of MMS as a treatment option for LM and LMM with that of traditional surgical and nonsurgical therapies by analyzing the published recurrence rates of these lesions after MMS procedures. METHODS AND MATERIALS PubMed database was used to find relevant articles with search terms related to MMS, LM, and LMM. RESULTS The search strategy resulted in 27 articles that fulfilled the inclusion criteria. All studies considered; MMS provided a 1.35% recurrence rate with follow-up times ranging from 1 month to 5 years. Specifically, studies employing classical MMS and MMS with rush sections provided recurrence rates of 1.17% and 2.4%, respectively. CONCLUSION MMS is one of the most successful treatment options for LM and LMM, with published evidence of improved recurrence rates when compared to other forms of therapy. Additional clinical trials are needed to further delineate the role of MMS in the treatment algorithm for these conditions.
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Affiliation(s)
- Ajay N Sharma
- Department of Dermatology, University of California, Irvine, CA, USA.,School of Medicine, University of California, Irvine, CA, USA
| | - Delila P Foulad
- Department of Dermatology, University of California, Irvine, CA, USA
| | - Linda Doan
- Department of Dermatology, University of California, Irvine, CA, USA
| | - Patrick K Lee
- Department of Dermatology, University of California, Irvine, CA, USA
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12
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Lackey AE, Glassman G, Grichnik J, McDonald J, Correa-Selm L. Repigmentation of gray hairs with lentigo maligna and response to topical imiquimod. JAAD Case Rep 2019; 5:1015-1017. [PMID: 31763424 PMCID: PMC6864298 DOI: 10.1016/j.jdcr.2019.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
| | | | - James Grichnik
- Cutaneous Oncology Division, Scully-Welsh Cancer Center, Cleveland Clinic Indian River Hospital, Vero Beach, Florida
| | - John McDonald
- Volunteer Faculty, Florida State University College of Medicine, Tallahassee, Florida
| | - Lilia Correa-Selm
- Cutaneous Oncology Division, Scully-Welsh Cancer Center, Cleveland Clinic Indian River Hospital, Vero Beach, Florida
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13
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Donigan JM, Hyde MA, Goldgar DE, Hadley ML, Bowling M, Bowen GM. Rate of Recurrence of Lentigo Maligna Treated With Off-Label Neoadjuvant Topical Imiquimod, 5%, Cream Prior to Conservatively Staged Excision. JAMA Dermatol 2019; 154:885-889. [PMID: 29847610 DOI: 10.1001/jamadermatol.2018.0530] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Staged excision of lentigo maligna (LM) often requires multiple stages and can result in significant cosmetic morbidity. Imiquimod cream has been used off-label as monotherapy in the treatment of LM and may be used in the neoadjuvant setting prior to staged excision as a strategy to reduce the size of the surgical margins required to confirm negative histologic margins. Objective To examine the rate of recurrence of LM in patients treated with neoadjuvant topical imiquimod, 5%, cream prior to conservatively staged excisions. Design, Setting, and Participants This was a retrospective medical record review of 334 patients with 345 biopsy-confirmed LM tumors from June 2004 to January 2012 who were treated with imiquimod prior to undergoing staged excisions at the University of Utah Medical Center and Huntsman Cancer Institute, large academic hospitals in Salt Lake City. Interventions Patients were treated with off-label imiquimod, 5%, cream 5 nights per week for 2 to 3 months. Those deemed to have an inadequate inflammatory response were also treated with tazarotene, 0.1%, gel twice weekly. Conservatively staged excisions, beginning with 2-mm margins, were then performed. Main Outcomes and Measures The rate of recurrence of LM after long-term follow-up. Results Patients included 235 men (70%) and 99 women (30%) with a mean (SD) age of 67 (13) years. Patients were treated with imiquimod cream for a mean of 2.5 months prior to undergoing conservatively staged excisions. There were 12 local recurrences (a rate of 3.9%) with a mean time to recurrence of 4.3 years and a mean length of follow-up of 5.5 years. Conclusions and Relevance Neoadjuvant topical imiquimod, 5%, cream prior to conservatively staged excisions for LM allowed for negative histologic margins with a median final margin of 2 mm and a rate of recurrence similar to reported recurrence rates with standard staged excisions by either Mohs surgery or en face permanent sections.
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Affiliation(s)
| | - Mark A Hyde
- Department of Dermatology, University of Utah, Salt Lake City.,Huntsman Cancer Institute, Salt Lake City, Utah
| | - David E Goldgar
- Department of Dermatology, University of Utah, Salt Lake City.,Huntsman Cancer Institute, Salt Lake City, Utah
| | | | | | - Glen M Bowen
- Department of Dermatology, University of Utah, Salt Lake City.,Huntsman Cancer Institute, Salt Lake City, Utah
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14
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Fikrle T, Divišová B, Šuchmannová J, Pizinger K. The use of 2940-nm ER:YAG laser for the treatment of lentigo maligna. J Dtsch Dermatol Ges 2019; 17:425-431. [PMID: 30933436 DOI: 10.1111/ddg.13814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 10/16/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Lentigo maligna is a common in situ malignancy in elderly patients, with a low risk of progression to an invasive tumor. Surgical treatment may be complicated or refused. Non-surgical treatment options (such as lasers) may therefore be needed. PATIENTS AND METHODS We report on 17 patients treated with a 2940-nm Er:YAG (erbium-doped yttrium aluminum) laser for histopathologically confirmed lentigo maligna. The lesions were ablated with a 5 mm margin of adjacent skin under local anesthesia with a 3.5 mm overlapping spot, energy density of 6.5 J/cm2 and a repetition rate of 5 Hz. If clinically visible pigmentation was seen in the ablated area during the following three months, the lesion was re-treated. All patients were followed up for residual or recurrent tumors. RESULTS We achieved clinical clearance in all 17 patients. There were three recurrences during the follow-up period (9, 30 and 36 months after laser therapy). All patients were satisfied with the treatment course and cosmetic outcome. The mean follow-up duration was 28 months. CONCLUSIONS Laser ablation is an interesting alternative method for treatment of lentigo maligna. It can be used for selected cases where surgery is contraindicated, complicated or declined by the patient.
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Affiliation(s)
- Tomáš Fikrle
- Department of Dermatovenereology, Charles University, Faculty of Medicine and Teaching Hospital in Pilsen, Czech Republic
| | - Barbora Divišová
- Department of Dermatovenereology, Charles University, Faculty of Medicine and Teaching Hospital in Pilsen, Czech Republic
| | - Jitka Šuchmannová
- Department of Dermatovenereology, Charles University, Faculty of Medicine and Teaching Hospital in Pilsen, Czech Republic
| | - Karel Pizinger
- Department of Dermatovenereology, Charles University, Faculty of Medicine and Teaching Hospital in Pilsen, Czech Republic
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15
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Fikrle T, Divišová B, Šuchmannová J, Pizinger K. Einsatz des 2940 nm ER:YAG‐Lasers zur Behandlung der Lentigo maligna. J Dtsch Dermatol Ges 2019; 17:425-432. [DOI: 10.1111/ddg.13814_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 10/16/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Tomáš Fikrle
- Department of DermatovenereologyCharles UniversityFaculty of Medicine and Teaching Hospital in Pilsen Tschechien
| | - Barbora Divišová
- Department of DermatovenereologyCharles UniversityFaculty of Medicine and Teaching Hospital in Pilsen Tschechien
| | - Jitka Šuchmannová
- Department of DermatovenereologyCharles UniversityFaculty of Medicine and Teaching Hospital in Pilsen Tschechien
| | - Karel Pizinger
- Department of DermatovenereologyCharles UniversityFaculty of Medicine and Teaching Hospital in Pilsen Tschechien
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16
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Papanikolaou M, Lawrence CM. Long-term outcomes of imiquimod-treated lentigo maligna. Clin Exp Dermatol 2019; 44:631-636. [PMID: 30663131 DOI: 10.1111/ced.13896] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lentigo maligna (LM) may be disfiguring and can progress to LM melanoma. Surgical excision remains the mainstay of treatment, but may result in disfigurement when used for large facial lesions. Topical imiquimod is a nonsurgical alternative although data on its long-term efficacy remain limited. AIM To assess long-term outcomes of LM treated with imiquimod cream. METHODS We collected data retrospectively for 33 patients treated with imiquimod cream for biopsy-proven LM from 2001 to 2016. Patients initially applied imiquimod once daily, 5 days/week for 6 weeks, aiming to produce a brisk local inflammatory response. If there was no response, the dose was increased to twice daily 7 days/week for 6 weeks and if again there was no response, to twice daily for 10 weeks. RESULTS An inflammatory response developed in 29 (88%) of the 33 patients, and of these, 4 patients stopped treatment earlier than planned because they could not tolerate the inflammatory reaction, while 3 patients reported systemic side effects. There was lesion clearance in 21 (72%) of the 29 patients, and they remained clear after a mean follow-up of 4.1 years. Eight failed to clear; in five the lesion was excised, while the remaining three were managed expectantly. CONCLUSIONS Our results support the use of imiquimod as an alternative to surgery for the treatment of LM in selected cases. With adequate patient preparation, imiquimod is generally tolerated and can achieve excellent cosmetic results. A clinical response is more likely if there is a brisk inflammatory response, and LM will not resolve if there is no inflammatory response.
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Affiliation(s)
- M Papanikolaou
- Department of Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - C M Lawrence
- Department of Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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17
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Connolly KL, Giordano C, Dusza S, Busam KJ, Nehal K. Follicular involvement is frequent in lentigo maligna: Implications for treatment. J Am Acad Dermatol 2018; 80:532-537. [PMID: 30266559 DOI: 10.1016/j.jaad.2018.07.071] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 07/16/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Follicular involvement of lentigo maligna (LM) is considered a histopathologic hallmark, but its prevalence and characteristics have not been well defined. The depth of intrafollicular extension by neoplastic melanocytes may have clinical importance in the treatment of LM. OBJECTIVE To describe the prevalence and features of follicular involvement in LM, including depth of follicular growth by melanocytes. METHODS A single-center retrospective study of 100 consecutive cases of surgically excised LM that was treated from 2013 to 2015. The slide review for cases with residual LM on the debulk specimen was performed by a dermatologic surgeon and dermatopathologist to characterize follicular involvement. RESULTS Of 100 specimens, 72 met the inclusion criteria for histopathologic evaluation. Follicular involvement was seen in 95.8% of specimens (95% confidence interval, 88.3%-99.1%), with a mean of 68% of follicles involved in a single specimen. The mean depth of intrafollicular growth by lesional melanocytes was 0.45 mm (standard deviation, 0.23; range, 0.1-1.1 mm). Tumor cells were confined to the infundibular portion of the hair follicle in 60.9% of specimens. CONCLUSION Superficial follicular involvement is a ubiquitous finding in LM. When treatment options for LM with a depth-dependent modality aiming for tumor clearance are being considered, mean and maximum depths of involvement should be taken into consideration.
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Affiliation(s)
- Karen L Connolly
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Cerrene Giordano
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephen Dusza
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Klaus J Busam
- Pathology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kishwer Nehal
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York.
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18
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Zhang J, Yu M, Li X, Huang X, Wang H. Combination therapy improves immune response and prognosis in patients with advanced oral mucosal melanoma: A clinical treatment success. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126:307-316. [PMID: 29958936 DOI: 10.1016/j.oooo.2018.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/22/2018] [Accepted: 05/07/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study was undertaken to analyze disease response and immune response to assess treatment effectiveness and success in patients with advanced oral mucosal melanoma treated with cytokines injection, cryosurgery, and adoptive cell transfer therapy. STUDY DESIGN Ten patients were enrolled in the study, and the relevant characteristics and immunologic differences were evaluated. RESULTS All patients achieved an objective clinical response according to the Response Evaluation Criteria in Solid Tumors, including 7 cases of continuing complete remission (55, 27, 87 + , 58+, 58 + , 45 + , and 37 + months) and 3 cases of partial remission (30, 12, and 9 months). Five responders are currently alive. After combination therapy, we observed that the proportion of CD3+ lymphocytes and the secretion of interferon-γ increased, whereas interleukin-10 decreased. In the assay of improved cytokine-induced killer cells, CD4+CD25+ regulatory T cells declined, and natural killer cells upregulated. Meanwhile, the proliferation rate of in vitro cultured improved cytokine-induced killer cells improved after courses of therapy. CONCLUSIONS Combination therapy of cytokine injection, cryosurgery, and transfer of improved cytokine-induced killer cells may be a promising approach for patients with oral mucosal melanoma.
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Affiliation(s)
- Jing Zhang
- Department of Oral and Maxillofacial Surgery, Clinical Laboratory, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Mei Yu
- Department of Oral and Maxillofacial Surgery, Clinical Laboratory, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Xiaolong Li
- Department of Oral and Maxillofacial Surgery, Clinical Laboratory, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Xiaofeng Huang
- Department of Oral and Maxillofacial Surgery, Clinical Laboratory, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Hua Wang
- Department of Oral and Maxillofacial Surgery, Clinical Laboratory, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China.
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19
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20
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Beveridge J, Taher M, Zhu J, Mahmood MN, Salopek TG. Staged margin-controlled excision (SMEX) for lentigo maligna melanoma in situ. J Surg Oncol 2018; 118:144-149. [DOI: 10.1002/jso.25109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 04/16/2018] [Accepted: 04/25/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Julie Beveridge
- Division of Plastic Surgery; University of Alberta; Edmonton Alberta Canada
| | - Muba Taher
- Division of Dermatology, Department of Medicine; University of Alberta; Edmonton Alberta Canada
| | - Jay Zhu
- Division of Plastic Surgery; University of Alberta; Edmonton Alberta Canada
| | - Muhammad N. Mahmood
- Department of Laboratory Medicine and Pathology; University of Alberta; Edmonton Alberta Canada
| | - Thomas G. Salopek
- Division of Dermatology, Department of Medicine; University of Alberta; Edmonton Alberta Canada
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21
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Pellacani G, De Carvalho N, Ciardo S, Ferrari B, Cesinaro A, Farnetani F, Bassoli S, Guitera P, Star P, Rawson R, Rossi E, Magnoni C, Gualdi G, Longo C, Scope A. The smart approach: feasibility of lentigo maligna superficial margin assessment with hand-held reflectance confocal microscopy technology. J Eur Acad Dermatol Venereol 2018; 32:1687-1694. [DOI: 10.1111/jdv.15033] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 03/28/2018] [Indexed: 11/29/2022]
Affiliation(s)
- G. Pellacani
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - N. De Carvalho
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - S. Ciardo
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - B. Ferrari
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - A.M. Cesinaro
- Department of Pathology; University of Modena and Reggio Emilia; Modena Italy
| | - F. Farnetani
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - S. Bassoli
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - P. Guitera
- Melanoma Institute Australia; Sydney NSW Australia
- The University of Sydney; Sydney NSW Australia
| | - P. Star
- Melanoma Institute Australia; Sydney NSW Australia
- The University of Sydney; Sydney NSW Australia
| | - R. Rawson
- Melanoma Institute Australia; Sydney NSW Australia
- The University of Sydney; Sydney NSW Australia
- Tissue Pathology and Diagnostic Oncology; Royal Prince Alfred Hospital; Camperdown NSW Australia
| | - E. Rossi
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - C. Magnoni
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - G. Gualdi
- Department of Dermatolgy; Spedali Civili di Brescia; Brescia Italy
| | - C. Longo
- Skin Cancer Unit; IRCCS - Santa Maria Nuova; Reggio Emilia Italy
| | - A. Scope
- Medical Screening Institute; Sheba Medical Center and Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
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22
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Tio D, Prinsen C, Dréno B, Hoekzema R, Augustin M, van Montfrans C. Variation in the diagnosis and clinical management of lentigo maligna across Europe: a survey study among European Association of Dermatologists and Venereologists members. J Eur Acad Dermatol Venereol 2018; 32:1476-1484. [DOI: 10.1111/jdv.14850] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 01/25/2018] [Indexed: 11/30/2022]
Affiliation(s)
- D. Tio
- Department of Dermatology; Vrije Universeit Medical Center Amsterdam; Amsterdam The Netherlands
| | - C.A.C. Prinsen
- Department of Epidemiology and Biostatistics; Amsterdam Public Health Research Institute; VU University Medical Center; Amsterdam The Netherlands
| | - B. Dréno
- Department of Dermatology; Centre Hospitalier Universitaire; Nantes France
| | - R. Hoekzema
- Department of Dermatology; Vrije Universiteit Medical Center Amsterdam; Amsterdam The Netherlands
| | - M. Augustin
- Dermatologic Institute for Health Services Research in Dermatology and Nursing; Hamburg Germany
| | - C. van Montfrans
- Department of Dermatology; Erasmus Medical Center Rotterdam; Rotterdam The Netherlands
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23
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Long-Term Outcomes of Melanoma In Situ Treated With Topical 5% Imiquimod Cream: A Retrospective Review. Dermatol Surg 2017; 43:1017-1022. [DOI: 10.1097/dss.0000000000001115] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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24
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Ponzo MG, Crawford RI, Kossintseva I. Amelanotic Lentigo Maligna Melanoma: Mohs Surgery as the Definitive Treatment of an Invisible Tumour. J Cutan Med Surg 2017; 22:51-57. [DOI: 10.1177/1203475417719046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Amelanotic lentigo maligna melanoma represents <2% of melanomas. Diagnosis is delayed owing to the lack of lesion pigmentation and advanced disease at presentation. Excision with appropriate margins is the treatment standard, but the starting point for such margins is often unclear. We describe 2 patients with amelanotic melanoma treated by Mohs micrographic surgery (MMS) that would not have been cleared by wide local excision alone and provide an extensive review of the literature. Both patients presented with histologic diagnoses of malignant melanoma, one with a barely perceptible biopsy site scar on the left infraorbital cheek/lower eyelid (Breslow 1.8 mm) and the second with an amelanotic tumour on the right helix (Breslow 10 mm). Due to location, aggressive histology, amelanotic appearance, and no apparent surrounding skin surface changes, MMS was elected to maximise margin control. For patient 1, invasive and in situ tumour was found at the American Joint Committee on Cancer–recommended margin of 1.5 cm, and the final defect measured 8.5 × 4.8 cm. Patient 2 had a significant invasive and amelanotic lentigo maligna component, resulting in a 9.0 × 6.5-cm defect. MMS allows for immediate histologic feedback on tumour margins of a clinically invisible tumour and thus offers the most definitive treatment.
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Affiliation(s)
- Marisa Grace Ponzo
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Richard Ian Crawford
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Irèn Kossintseva
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
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25
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Eigentler TK, Mühlenbein C, Follmann M, Schadendorf D, Garbe C. S3-Leitlinie Diagnostik, Therapie und Nachsorge des Melanoms - Update 2015/2016, Kurzversion 2.0. J Dtsch Dermatol Ges 2017; 15:e1-e41. [DOI: 10.1111/ddg.13247] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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26
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Time to local recurrence of lentigo maligna: Implications for future studies. J Am Acad Dermatol 2017; 74:1247-8. [PMID: 27185424 DOI: 10.1016/j.jaad.2016.02.1150] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 02/01/2016] [Accepted: 02/03/2016] [Indexed: 11/23/2022]
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27
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Garcia D, Eilers RE, Jiang SB. Recurrence Rate of Melanoma in Situ when Treated with Serial Disk Staged Excision: A Case Series. ACTA ACUST UNITED AC 2017; 5. [PMID: 28936478 PMCID: PMC5603294 DOI: 10.13188/2373-1044.1000037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Cutaneous melanoma is one of the fastest rising cancer diagnoses in recent years. Melanoma in situ (MIS) constitutes a large proportion of all diagnosed melanomas. While surgical excision is considered the standard of therapy, the literature is not clear on which surgical technique minimizes local recurrence. A common technique is serial staged excision (SSE), in which a series of mapped excisions are made according to histopathological examination of tissue. Previously published recurrence rates for SSE ranges from 0–12%, over a range of 4.7–97 months of mean follow-up. Objective To investigate the recurrence rate of MIS when excised using a serial disk staged excision technique with tissue marked at 12 O’clock for mapping, rush permanent processing and histologic examination, 3-suture tagging for subsequent stages, and “breadloafing” microscopic analysis. Additionally, to determine the relationship between initial lesion size and subsequent stages of excision required for clearance, and final surgical margin. Methods Single-institution retrospective chart review of 29 biopsy confirmed MIS lesions treated with our variant of SSE. Statistical analysis via independent t-tests. Results No recurrences were observed with mean follow-up of 31.5 months (SD 13.9), over range of 12–58 months. Mean surgical margin of 13.1 mm (SD 5.9). A trend towards larger surgical margin was seen with increasing pre-operative lesion size. Conclusion This method of SSE for treatment of MIS is comparable in efficacy to other SSE techniques, and may offer physicians a relatively simple, efficacious, and accessible alternative to wide local excision and Mohs micrographic surgery.
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Affiliation(s)
- Daniel Garcia
- Department of Dermatology, Dermatologic and Mohs Micrographic Surgery Center, San Diego School of Medicine, University of California
| | - Robert E Eilers
- Department of Dermatology, Dermatologic and Mohs Micrographic Surgery Center, San Diego School of Medicine, University of California
| | - S Brian Jiang
- Department of Dermatology, Dermatologic and Mohs Micrographic Surgery Center, San Diego School of Medicine, University of California
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28
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Eber AE, Magno RJ, Tsatalis JP, Perper M, Aldahan AS, Nouri K. Cells to Surgery Quiz: October 2016. J Invest Dermatol 2016; 136:e107. [PMID: 30477728 DOI: 10.1016/j.jid.2016.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Ariel E Eber
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Robert J Magno
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - John P Tsatalis
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Marina Perper
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Adam S Aldahan
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Keyvan Nouri
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
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29
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Wong JG, Toole JW, Demers AA, Musto G, Wiseman MC. Topical 5% Imiquimod in the Treatment of Lentigo Maligna. J Cutan Med Surg 2016; 16:245-9. [DOI: 10.1177/120347541201600405] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Standard treatment for lentigo maligna (LM) is surgical excision with 5 to 10 mm margins. This can be cosmetically disfiguring. Imiquimod locally induces Toll-like receptors to release cytokines that destroy neoplastic melanocytes. Objective: The off-label use of topical 5% imiquimod cream may provide an alternative to surgery. This study reviews the use of imiquimod to treat LM. Methods: A 5-year retrospective and prospective chart analysis was conducted. Pretreatment biopsies confirmed the diagnosis. Treatment was individualized for each patient. Posttreatment biopsies and dermoscopy determined clearance of LM. Results: Twenty-seven patients were reviewed. There were 20 responders (74.1%) and 7 failures. The mean tumor size (area of an ellipse) was 6.69 cm2, and the mean treatment duration was 17.68 weeks. Neither the size of the tumor ( p = .86) nor treatment duration ( p = .18) was related to resolution of the lesion. Conclusion: Imiquimod is an effective treatment for LM that provides patients with a cosmetically favorable outcome when standard surgery is not an option.
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Affiliation(s)
- Jessica G. Wong
- Faculty of Medicine and Section of Dermatology, Departments of Internal Medicine and Dermatology, University of Manitoba
| | - Jack W.P. Toole
- Faculty of Medicine and Section of Dermatology, Departments of Internal Medicine and Dermatology, University of Manitoba
| | | | - Grace Musto
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba
| | - Marni C. Wiseman
- CancerCare Manitoba, Department of Internal Medicine, Section of Dermatology, Section of Hematology and Oncology, Winnipeg, MB
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30
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Greveling K, de Vries K, van Doorn MBA, Prens EP. A two-stage treatment of lentigo maligna using ablative laser therapy followed by imiquimod: excellent cosmesis, but frequent recurrences on the nose. Br J Dermatol 2016; 174:1134-6. [PMID: 26615810 DOI: 10.1111/bjd.14330] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- K Greveling
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Burg s'Jacobplein 51, 3015 CA, Rotterdam, the Netherlands.
| | - K de Vries
- Department of Dermatology, University Medical Center Groningen, Groningen, the Netherlands
| | - M B A van Doorn
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Burg s'Jacobplein 51, 3015 CA, Rotterdam, the Netherlands
| | - E P Prens
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Burg s'Jacobplein 51, 3015 CA, Rotterdam, the Netherlands
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31
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de Vries K, Greveling K, Prens L, Munte K, Koljenović S, van Doorn M, Prens E. Recurrence rate of lentigo maligna after micrographically controlled staged surgical excision. Br J Dermatol 2016; 174:588-93. [DOI: 10.1111/bjd.14325] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2015] [Indexed: 11/29/2022]
Affiliation(s)
- K. de Vries
- Department of Dermatology; University Medical Center Groningen; Groningen the Netherlands
- Department of Dermatology; Erasmus University Medical Center; 3000 CA Rotterdam the Netherlands
| | - K. Greveling
- Department of Dermatology; Erasmus University Medical Center; 3000 CA Rotterdam the Netherlands
| | - L.M. Prens
- Department of Dermatology; Erasmus University Medical Center; 3000 CA Rotterdam the Netherlands
| | - K. Munte
- Department of Dermatology; Maasstad Ziekenhuis; Rotterdam the Netherlands
| | - S. Koljenović
- Department of Pathology; Erasmus University Medical Center; 3000 CA Rotterdam the Netherlands
| | - M.B.A. van Doorn
- Department of Dermatology; Erasmus University Medical Center; 3000 CA Rotterdam the Netherlands
| | - E.P. Prens
- Department of Dermatology; Erasmus University Medical Center; 3000 CA Rotterdam the Netherlands
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32
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Kai A, Richards T, Coleman A, Mallipeddi R, Barlow R, Craythorne E. Five‐year recurrence rate of lentigo maligna after treatment with imiquimod. Br J Dermatol 2015; 174:165-8. [DOI: 10.1111/bjd.14311] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2015] [Indexed: 11/30/2022]
Affiliation(s)
- A.C. Kai
- Dermatological Surgery and Laser Unit St John's Institute of Dermatology Guy's and St Thomas’ NHS Foundation Trust 3rd Floor, Staircase C Westminster Bridge Road London SE1 7EH U.K
| | - T. Richards
- Department of Biomedical Engineering Kings College London London U.K
| | - A. Coleman
- Department of Biomedical Engineering Kings College London London U.K
| | - R. Mallipeddi
- Dermatological Surgery and Laser Unit St John's Institute of Dermatology Guy's and St Thomas’ NHS Foundation Trust 3rd Floor, Staircase C Westminster Bridge Road London SE1 7EH U.K
| | - R. Barlow
- Dermatological Surgery and Laser Unit St John's Institute of Dermatology Guy's and St Thomas’ NHS Foundation Trust 3rd Floor, Staircase C Westminster Bridge Road London SE1 7EH U.K
| | - E.E. Craythorne
- Dermatological Surgery and Laser Unit St John's Institute of Dermatology Guy's and St Thomas’ NHS Foundation Trust 3rd Floor, Staircase C Westminster Bridge Road London SE1 7EH U.K
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33
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Juhász MLW, Marmur ES. Reviewing Challenges in the Diagnosis and Treatment of Lentigo Maligna and Lentigo-Maligna Melanoma. ACTA ACUST UNITED AC 2015; 3:133-145. [PMID: 27182482 PMCID: PMC4837936 DOI: 10.1007/s40487-015-0012-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Indexed: 10/31/2022]
Abstract
Lentigo maligna (LM) and lentigo-maligna melanoma (LMM) are pigmented skin lesions that may exist on a continuous clinical and pathological spectrum of melanocytic skin cancer. LM is often described as a "benign" lesion and is accepted as a melanoma in situ; LM can undergo malignant transformation to particularly aggressive melanoma. LMM is an invasive melanoma that shares properties of LM, as well as exhibiting the metastatic potential of malignant melanoma. Unfortunately, LM/LMM diagnosis based on dermoscopy is rather ambiguous, and these lesions are often mistaken for junctional dysplastic nevi over sun-damaged skin, pigmented actinic keratosis, solar lentigo, or seborrheic keratosis. Diagnosis must be made on biopsy using distinct dermatopathologic features. These include a pagetoid appearance of melanocytes, melanocyte atypia, non-uniform pigmentation/distribution of melanocytes, and increased melanocyte density in a background of extensive photodamage. Advancements in immunohistochemical staining techniques, including soluble adenylyl cyclase (antibody R21), makes diagnosis easier and allows the definition of borders down to a single cell. After a pathologic diagnosis, there are a variety of treatment options, both surgical and non-surgical. Although surgical removal with a wide excision border is the preferred treatment due to decreased recurrence rates, experimental combination therapies are gaining popularity. However, no matter the treatment, LM/LMM carries a high recurrence rate, and patients must be monitored rigorously for recurrence as well as the appearance of additional skin lesions/cancers.
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Affiliation(s)
- Margit L W Juhász
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY USA
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34
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Read T, Noonan C, David M, Wagels M, Foote M, Schaider H, Soyer HP, Smithers BM. A systematic review of non-surgical treatments for lentigo maligna. J Eur Acad Dermatol Venereol 2015; 30:748-53. [PMID: 26299846 DOI: 10.1111/jdv.13252] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 05/22/2015] [Indexed: 11/26/2022]
Abstract
Lentigo maligna (LM) is the most common melanocytic malignancy of the head and neck. If left untreated, LM can progress to lentigo maligna melanoma (LMM). Complete surgical excision is the gold standard for treatment, however, due to the location, size, and advanced age of patients, surgery is not always acceptable. As a result, there is ongoing interest in alternative, less invasive treatment modalities. The objective was to provide a structured review of key literature reporting the use of radiotherapy, imiquimod and laser therapy for the management of LM in patients where surgical resection is prohibited. An independent review was conducted following a comprehensive search of the National Library of Medicine using MEDLINE and PubMed, Embase, Scopus, ScienceDirect and Cochrane Library databases. Data were presented in tabular format, and crude data pooled to calculate mean recurrence rates for each therapy. 29 studies met the inclusion criteria: radiotherapy 10; topical imiquimod 10; laser therapies 9. Radiotherapy demostrated recurrence rates of up to 31% (mean 11.5%), with follow-up durations of 1-96 months. Topical imiquimod recurrence rates were up to 50% (mean 24.5%), with follow-up durations of 2-49 months. Laser therapy yielded recurrence rates of up to 100% (mean 34.4%), and follow-up durations of 8-78 months. in each of the treatment series the I(2) value measuring statistical heterogeneity exceeded the accepted threshold of 50% and as such a meta-analysis of included data were inappropriate. For non-surgical patients with LM, radiotherapy and topical imiquimod were efficacious treatments. Radiotherapy produced superior complete response rates and fewer recurrences than imiquimod although both are promising non-invasive modalities. There was no consistent body of evidence regarding laser therapy although response rates of up to 100% were reported in low quality studies. A prospective comparative trial is indicated and would provide accurate data on the long-term efficacy and overall utility of these treatments.
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Affiliation(s)
- T Read
- Queensland Melanoma Project, Princess Alexandra Hospital, Queensland Health, Brisbane, QLD, Australia.,Discipline of Surgery, School of Medicine, The University of Queensland, Princess Alexandra Hospital, Brisbane, QLD, Australia.,School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - C Noonan
- School of Medicine, Griffith University, Gold Coast, QLD, Australia.,Department of Radiation Oncology, Christchurch Hospital, Canterbury District Health, Christchurch, New Zealand
| | - M David
- Faculty of Medicine and Biomedical Sciences, School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - M Wagels
- Queensland Melanoma Project, Princess Alexandra Hospital, Queensland Health, Brisbane, QLD, Australia.,Discipline of Surgery, School of Medicine, The University of Queensland, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - M Foote
- Queensland Melanoma Project, Princess Alexandra Hospital, Queensland Health, Brisbane, QLD, Australia
| | - H Schaider
- Dermatology Research Centre, Translational Research Institute, School of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - H P Soyer
- Dermatology Research Centre, Translational Research Institute, School of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - B M Smithers
- Queensland Melanoma Project, Princess Alexandra Hospital, Queensland Health, Brisbane, QLD, Australia.,Discipline of Surgery, School of Medicine, The University of Queensland, Princess Alexandra Hospital, Brisbane, QLD, Australia
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Higgins HW, Lee KC, Galan A, Leffell DJ. Melanoma in situ: Part II. Histopathology, treatment, and clinical management. J Am Acad Dermatol 2015; 73:193-203; quiz 203-4. [PMID: 26183968 DOI: 10.1016/j.jaad.2015.03.057] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 03/18/2015] [Accepted: 03/31/2015] [Indexed: 11/20/2022]
Abstract
Melanoma in situ (MIS) poses special challenges with regard to histopathology, treatment, and clinical management. The negligible mortality and normal life expectancy associated with patients with MIS should guide treatment for this tumor. Similarly, the approach to treatment should take into account the potential for MIS to transform into invasive melanoma, which has a significant impact on morbidity and mortality. Part II of this continuing medical education article reviews the histologic features, treatment, and management of MIS.
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Affiliation(s)
- H William Higgins
- Department of Dermatology, Brown University School of Medicine, Providence, Rhode Island.
| | - Kachiu C Lee
- Department of Dermatology, Brown University School of Medicine, Providence, Rhode Island
| | - Anjela Galan
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - David J Leffell
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
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Connolly KL, Nehal KS, Busam KJ. Lentigo maligna and lentigo maligna melanoma: contemporary issues in diagnosis and management. Melanoma Manag 2015; 2:171-178. [PMID: 30190846 DOI: 10.2217/mmt.15.3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Lentigo maligna and lentigo maligna melanomas present diagnostic and treatment dilemmas due to their frequent presence within a background of sun-damaged skin, and their location on cosmetically and functionally sensitive areas. As the incidence of this entity is increasing, diagnostic and management controversies have developed. While surgery remains the gold standard of treatment, nonsurgical treatment options are also emerging for both adjunctive and primary therapy.
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Affiliation(s)
- Karen L Connolly
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kishwer S Nehal
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Klaus J Busam
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Five-Year Outcomes of Wide Excision and Mohs Micrographic Surgery for Primary Lentigo Maligna in an Academic Practice Cohort. Dermatol Surg 2015; 41:211-8. [DOI: 10.1097/dss.0000000000000248] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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38
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Combination Topical Therapy for Conjunctival Primary Acquired Melanosis With Atypia and Periocular Lentigo Maligna. Cornea 2015; 34:90-3. [DOI: 10.1097/ico.0000000000000277] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fan Q, Cohen S, John B, Riker AI. Melanoma in Situ Treated with Topical Imiquimod for Management of Persistently Positive Margins: A Review of Treatment Methods. Ochsner J 2015; 15:443-7. [PMID: 26730231 PMCID: PMC4679308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Imiquimod is a topical cream approved by the US Food and Drug Administration for treatment of superficial basal cell carcinoma, actinic keratosis, and genital-perianal warts. Its successful use in patients with persistently positive margins of melanoma in situ (MIS) after surgical excision has been previously reported. CASE REPORT A 75-year-old female presented with a primary melanoma that was removed through an elliptical excision with 1 cm margins. Pathology revealed 3 involved margins with residual MIS without an invasive component. After a second operation removed an additional 1 cm margin, pathology revealed 2 positive margins with residual MIS. Rather than undergoing a third excision, the patient decided to pursue a nonsurgical approach with topical imiquimod, and at the 4-month follow-up examination, the incision was completely healed with no clinical evidence of tumor recurrence. CONCLUSION A nonsurgical approach with 5% topical imiquimod cream applied along the incision was utilized. In specific patient populations, the use of imiquimod is a reasonable alternative approach for the management of persistently positive MIS margins. Long-term follow-up is necessary to assess for evidence of recurrence and the ultimate success of this nonsurgical approach.
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Affiliation(s)
- Qing Fan
- General & Oncology Surgery Departments, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Stephanie Cohen
- Department of Surgery, Advocate Cancer Institute, Advocate Christ Medical Center, Oak Lawn, IL
| | - Becky John
- Department of Pathology, Advocate Lutheran General Hospital, Park Ridge, IL
| | - Adam I. Riker
- Department of Surgery, Advocate Cancer Institute, Advocate Christ Medical Center, Oak Lawn, IL
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Tzellos T, Kyrgidis A, Mocellin S, Chan AW, Pilati P, Apalla Z. Interventions for melanoma in situ, including lentigo maligna. Cochrane Database Syst Rev 2014; 2014:CD010308. [PMID: 25526608 PMCID: PMC11005944 DOI: 10.1002/14651858.cd010308.pub2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Malignant melanoma is a form of skin cancer associated with significant mortality once it has spread beyond the skin. Melanoma in situ (MIS) is the earliest histologically recognisable stage of malignant melanoma and represents a precursor of invasive melanoma. Lentigo maligna (LM) represents a subtype of pre-invasive intraepidermal melanoma associated specifically with chronic exposure to ultraviolet (UV) radiation. Over the past two decades, the incidence of MIS has increased significantly, even more than the invasive counterpart. There are several treatment options for MIS, but no consensus exists on the best therapeutic management of this condition. OBJECTIVES To assess the effects of all available interventions, surgical and non-surgical, for the treatment of melanoma in situ, including LM. SEARCH METHODS We searched the following databases up to November 2014: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2014, Issue 10), MEDLINE (from 1946), Embase (from 1974), LILACS (from 1982), African Index Medicus (from inception), IndeMED of India (from inception), and Index Medicus for the South-East Asia Region (IMSEAR) (from inception). We scanned the references of included and excluded studies for further references to relevant trials and searched five trials registries. We checked the abstracts of major dermatology and oncology conference proceedings, and we shared our lists of included and excluded studies with industry contacts and other experts in the field of melanoma to try to identify further relevant trials. SELECTION CRITERIA We included randomised controlled trials (RCT) on the management of MIS, including LM, that compared any intervention to placebo or active treatment. We included individuals, irrespective of age and sex, diagnosed with MIS, including LM, based on histological examination. DATA COLLECTION AND ANALYSIS Two authors independently evaluated possible studies for inclusion; extracted data from the included study using a standard data extraction form modified for our review; assessed risk of bias; and analysed data on efficacy, safety, and tolerability. They resolved any disagreements by discussion with a third author. We collected adverse effects information from included studies. MAIN RESULTS Our search identified only 1 study eligible for inclusion (and 1 ongoing study in active recruitment stage), which was a single centre, open label, parallel group, 2-arm RCT with 90 participants, who had 91 histologically proven LM lesions.Forty-four participants, with 44 LM lesions, were treated with imiquimod 5% cream 5 days per week plus tazarotene 0.1% gel 2 days/week for 3 months, and 46 participants, with 47 LM lesions, were treated with imiquimod 5% cream 5 days per week for 3 months. Two months after cessation of topical treatment, the initial tumour footprint was excised using 2 mm margins via a staged excision. This study was open label, and analysis was not intention-to-treat, leading to a high risk of incomplete outcome data.Our primary outcome 'Histological or clinical complete response' was measured at 5 months in 29/44 participants (66%) treated with imiquimod plus tazarotene (combination therapy) and 27/46 participants (59%) treated with imiquimod (monotherapy). The difference was not statistically significant (risk ratio (RR) 1.12, 95% confidence interval (CI) 0.81 to 1.55, P value = 0.48).With regard to our secondary outcomes on recurrence and inflammation, after a mean follow up of 42 months, no local recurrences were observed among complete responders. Difference in overall inflammation score between the 2 groups was significant (mean difference (MD) 0.6, 95% CI 0.2 to 1, P value = 0.004), with the mean overall inflammation score being significantly higher in the combination group.The study authors did not clearly report on side-effects. Because of adverse effects, there was a dropout rate of 6/44 participants (13.7%) in the combination group compared with 1/46 (2.2%) in the imiquimod monotherapy group (due to excessive inflammation) before the cessation of topical treatment (first 3 months), but this was not statistically significant (RR 6.27, 95% CI 0.79 to 50.02, P value = 0.08). AUTHORS' CONCLUSIONS There is a lack of high-quality evidence for the treatment of MIS and LM.For the treatment of MIS, we found no RCTs of surgical interventions aiming to optimise margin control (square method, perimeter technique, 'slow Mohs', staged radial sections, staged "mapped" excisions, or Mohs micrographic surgery), which are the most widely used interventions recommended as first-line therapy. The use of non-surgical interventions in selected cases (patients with contraindications to surgical interventions) may be effective and may be considered preferable for experienced providers and under close and adequate follow up.For the treatment of LM, we found no RCTs of surgical interventions, which remain the most widely used and recommended available treatment. The use of non-surgical interventions, such as imiquimod, as monotherapy may be effective and may be considered in selected cases where surgical procedures are contraindicated and used preferentially by experienced providers under close and adequate follow up. The use of topical therapies, such as 5-fluorouracil and imiquimod, as neoadjuvant therapies warrants further investigation. There is insufficient evidence to support or refute the addition of tazarotene to imiquimod as adjuvant therapy; the current evidence suggests that it can increase topical inflammatory response and withdrawal of participants because of treatment-related side-effects.
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Affiliation(s)
- Thrasivoulos Tzellos
- Department of Dermatology, Faculty of Health Sciences, University Hospital of North Norway, Harstad, Troms, Norway. .
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A model for lentigo maligna recurrence using melanocyte count as a predictive marker based upon logistic regression analysis of a blinded retrospective review. J Plast Reconstr Aesthet Surg 2014; 67:1322-32. [DOI: 10.1016/j.bjps.2014.05.058] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 05/26/2014] [Accepted: 05/27/2014] [Indexed: 11/24/2022]
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Management of Lentigo Maligna: Update on Surgical and Medical Treatments. CURRENT DERMATOLOGY REPORTS 2014. [DOI: 10.1007/s13671-014-0072-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Pflugfelder A, Kochs C, Blum A, Capellaro M, Czeschik C, Dettenborn T, Dill D, Dippel E, Eigentler T, Feyer P, Follmann M, Frerich B, Ganten MK, Gärtner J, Gutzmer R, Hassel J, Hauschild A, Hohenberger P, Hübner J, Kaatz M, Kleeberg UR, Kölbl O, Kortmann RD, Krause-Bergmann A, Kurschat P, Leiter U, Link H, Loquai C, Löser C, Mackensen A, Meier F, Mohr P, Möhrle M, Nashan D, Reske S, Rose C, Sander C, Satzger I, Schiller M, Schlemmer HP, Strittmatter G, Sunderkötter C, Swoboda L, Trefzer U, Voltz R, Vordermark D, Weichenthal M, Werner A, Wesselmann S, Weyergraf AJ, Wick W, Garbe C, Schadendorf D. S3-guideline "diagnosis, therapy and follow-up of melanoma" -- short version. J Dtsch Dermatol Ges 2014; 11:563-602. [PMID: 23721604 DOI: 10.1111/ddg.12044] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Samaniego E, Redondo P. Lentigo Maligna. ACTAS DERMO-SIFILIOGRAFICAS 2013. [DOI: 10.1016/j.adengl.2012.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Samaniego E, Redondo P. Lentigo maligno. ACTAS DERMO-SIFILIOGRAFICAS 2013; 104:757-75. [DOI: 10.1016/j.ad.2012.05.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 04/28/2012] [Accepted: 05/19/2012] [Indexed: 11/16/2022] Open
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de Vries K, Rellum R, Habets J, Prens E. A novel two-stage treatment of lentigo maligna using ablative laser therapy followed by imiquimod. Br J Dermatol 2013; 168:1362-4. [DOI: 10.1111/bjd.12157] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Iorizzo LJ, Chocron I, Lumbang W, Stasko T. Importance of Vertical Pathology of Debulking Specimens During Mohs Micrographic Surgery for Lentigo Maligna and Melanoma in Situ. Dermatol Surg 2013; 39:365-71. [DOI: 10.1111/dsu.12078] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hilari H, Llorca D, Traves V, Villanueva A, Serra-Guillén C, Requena C, Llombart B, Sanmartín O, Guillén C, Nagore E. Tratamiento quirúrgico del lentigo maligno: cirugía convencional vs. Mohs diferida. Estudio retrospectivo de 62 casos. ACTAS DERMO-SIFILIOGRAFICAS 2012; 103:614-23. [DOI: 10.1016/j.ad.2011.12.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 10/27/2011] [Accepted: 12/08/2011] [Indexed: 11/16/2022] Open
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49
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Hilari H, Llorca D, Traves V, Villanueva A, Serra-Guillén C, Requena C, Llombart B, Sanmartín O, Guillén C, Nagore E. Conventional Surgery Compared With Slow Mohs Micrographic Surgery in the Treatment of Lentigo Maligna: A Retrospective Study of 62 Cases. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.adengl.2012.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ellis LZ, Cohen JL, High W, Stewart L. Melanoma in situ treated successfully using imiquimod after nonclearance with surgery: review of the literature. Dermatol Surg 2012; 38:937-46. [PMID: 22338583 DOI: 10.1111/j.1524-4725.2012.02362.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND The standard of care for melanoma in situ (MIS) is surgical removal by surgical excision with a 5-mm margin or Mohs micrographic surgery, but as more and more MIS is diagnosed in the head and neck region, surgeries may not be an option for patients when the lesions are large or less well defined. In addition, when negative margins cannot be achieved without grossly disfiguring the patient or when patients have medical comorbidities that preclude a surgical option, other treatment modalities may be considered. Recently, topical treatment with an immunomodulator, imiquimod, has been proposed as an alternative treatment for MIS. OBJECTIVE We report a case of MIS successfully treated with topical imiquimod cream. In addition, because there has not been any comprehensive review of the use of topical imiquimod on melanoma and MIS, we conducted an extensive literature search and reviewed the topic in detail. MATERIALS AND METHODS Using the keywords "imiquimod," "melanoma," "melanoma-in-situ," and "lentigo maligna," we searched the literature using PubMed in an attempt to find all relevant articles on the use of imiquimod on MIS or melanoma. RESULTS There were 46 reports involving 264 patients on the use of imiquimod on MIS or lentigo maligna. Twenty-three reports were published on the use of imiquimod on metastatic melanoma involving 55 patients, and two articles were on melanoma, with two patients in total. In addition, there were two articles on the use of imiquimod on dysplastic or atypical nevi with a total of 13 subjects. CONCLUSION Imiquimod appears to be beneficial in the treatment of MIS and melanoma metastases when surgical options are not feasible. Imiquimod should not be used for removal of dysplastic or atypical nevi. The treatment regimens varied from study to study, and there are no randomized controlled trials in the literature. More studies are needed to develop a reliable and reproducible treatment regimen, to fully elucidate the role of imiquimod in the treatment of MIS and melanoma, and to determine the prognostic predictors for favorable responses to imiquimod.
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Affiliation(s)
- Lixia Z Ellis
- Department of Dermatology, University of Colorado, Aurora, Colorado 80045, USA.
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