Grenz ray treatment of lentigo maligna and early lentigo maligna melanoma.
BACKGROUND
Lentigo maligna (LM) is the in situ phase of lentigo maligna melanoma (LMM). A wide variety of modalities has been used to manage LM, including conventional surgery, staged excision, Mohs micrographic surgery, cryotherapy, radiotherapy, laser therapy, and, recently, imiquimod.


OBJECTIVE
Soft x-radiation is an accepted treatment for LM/LMM. The aim of the present study was to evaluate the efficacy and safety of ultra-soft x-ray/grenz-ray (GR) treatment in patients with LM and early LMM.


METHODS
Five hundred ninety-three patients were treated with GR (primary therapy, n = 350; partial excision followed by GR, n = 71; radical excision followed by GR as recurrence-prophylactic treatment, n = 172) at the Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden between 1990 and 2009. The treatment was given twice a week over 3 consecutive weeks in total doses of 100 to 160 Gy. Dosage depended on the stage of LM and the depth of periadnexal atypical melanocytic extension in histologically examined materials before treatment. Four hundred twenty-five patients have been followed up for at least 2 years; of these, 241 for 5 years.


RESULTS
Overall, 520 of 593 patients (88%) showed complete clearance after one fractionated treatment. Residual lesions were seen in 15 patients, and 58 relapsed, 53 of whom (72%) within 2 years.


CONCLUSIONS
Woods light examination was not used in the clinical diagnosis of lentigo maligna.


CONCLUSIONS
GR is an efficient and safe treatment in LM and early LMM when administered according to the recommendations presented herein. Moreover, GR offers an excellent cosmetic result.
Department of Medicine, Unit of Dermatology, Karolinska University Hospital Solna, Karolinska Institutet, Stockholm, Sweden. mari-anne.hedblad@karolinska.se
Mari-Anne
MA
Hedblad
Lotus
L
Mallbris
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D018327:Hutchinson's Melanotic Freckle / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011832:Radiation Injuries; D011879:Radiotherapy Dosage; D012878:Skin Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery