Staged excision of lentigo maligna and lentigo maligna melanoma: a 10-year experience.
BACKGROUND
The treatment of lentigo maligna and lentigo maligna melanoma presents a difficult problem for clinicians. Published guidelines recommend a 5-mm excision margin for lentigo maligna and a 1-cm margin for lentigo maligna melanoma, yet these are often inadequate. The authors' purpose is to report their 10-year experience using staged excision for the treatment of lentigo maligna and lentigo maligna melanoma of the head and neck.


METHODS
Staged excision was performed on 59 patients over a 10-year period. Data on patient demographics, lesion characteristics, and treatment were collected through an institutional review board-approved chart review.


RESULTS
Using staged excision, 62.7 percent of patients required a 10-mm or greater margin to achieve clearance of tumor. Two or more stages of excision were required in 50.9 percent of patients. Invasive melanoma (lentigo maligna melanoma) was identified in 10.2 percent of patients initially diagnosed with lentigo maligna. There was one (1.7 percent) documented recurrence during a median 2.25-year follow-up period (range, 0 to 10.17 years).


CONCLUSIONS
Staged excision is an effective treatment for lentigo maligna and lentigo maligna melanoma. Previously published recommendations of 5-mm margins for wide local excision are inadequate for tumors located on the head and neck.
Bosbous
Mark W
MW
Milwaukee, Wis. From the Departments of Plastic Surgery and Dermatology, Medical College of Wisconsin.
Dzwierzynski
William W
WW
Neuburg
Marcelle
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018327:Hutchinson's Melanotic Freckle / Q000473:pathology / Q000601:surgery*; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000517:prevention & control; D009367:Neoplasm Staging / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D024162:Second-Look Surgery / Q000592:standards*; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D013514:Surgical Procedures, Operative / Q000592:standards*; D013997:Time Factors; D016896:Treatment Outcome