Survey of U.K. current practice in the treatment of lentigo maligna.
BACKGROUND
Lentigo maligna (LM) is the in situ phase of LM melanoma (LMM). There is a paucity of data on the natural history of LM, the risk factors for progression to LMM and on treatment outcomes of the various modalities used.


OBJECTIVE
To investigate our impression that this, combined with the difficulties of treatment for large lesions particularly in the elderly and infirm, has led to considerable variation between dermatologists in the management of LM within the U.K.


METHODS
A postal questionnaire survey was performed to establish current practice.


RESULTS
One hundred and seventy clinicians representing one-third of U.K. consultant dermatologists responded. Fifty-seven per cent of the dermatologists reported treating only one to four LMs per year, 30% treated five to 10 LMs per year and only 13% treated more than 10 LMs per year. Ninety-four per cent of the respondents routinely took an initial biopsy to confirm the diagnosis and plan treatment. The preferred treatment option was dependent on the age of the patient. Dermatologists were far more likely to use surgery for patients under the age of 60 years and more likely to use cryotherapy/radiotherapy or merely to observe with increasing age. Where surgery was used, the excision margins chosen ranged from 0 to 10 mm.


CONCLUSIONS
This survey highlights that a significant proportion of U.K. dermatologists is managing small numbers of LMs each year. On the basis of this current practice and the data in the literature on the recurrence rates for the different modalities, we propose an algorithm for treatment options. The survey, however, showed no consensus between dermatologists regarding surgical margins for excision, which is reflected in the literature; further studies to establish this are required.
Mahendran
R M
RM
Department of Dermatology and ICRF Cancer Medicine Research Unit, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
Newton-Bishop
J A
JA
D000367:Age Factors; D000368:Aged; D000465:Algorithms; D019538:Health Care Surveys; D006801:Humans; D018327:Hutchinson's Melanotic Freckle / Q000601:surgery / Q000628:therapy*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012878:Skin Neoplasms / Q000601:surgery / Q000628:therapy*; D011795:Surveys and Questionnaires; D006113:United Kingdom