title: Conventional surgery compared with slow Mohs micrographic surgery in the treatment of lentigo maligna: a retrospective study of 62 cases.
abstract: BACKGROUND
  Surgical excision with margins of 0.5cm is the standard treatment for lentigo maligna (LM). Excision, however, is often incomplete as many of these tumors have indistinct borders.
  
  
  OBJECTIVE
  To identify clinical predictors of subclinical extension in primary and recurrent LM of the head and thereby determine which lesions might require wider surgical margins.
  
  
  METHODS
  We reviewed the clinical records of patients with LM of the head treated definitively with conventional surgical excision or slow micrographic Mohs surgery (MMS) at the dermatology department of Instituto Valenciano de Oncología between January 1993 and April 2011.
  
  
  RESULTS
  Surgical margins larger than 0.5cm were required in 69.2% of recurrent LM and 26.5% of primary LM. Factors associated with the need for wider margins were prior treatment that might have interfered with the clinical delineation of the border, lesions in the center of the face, and skin phototypes III to V.
  
  
  CONCLUSIONS
  Surgical margins of 0.5cm are inadequate for the treatment of a considerable number of LM lesions located on the head, particularly if these are recurrent. Slow MMS using paraffin-embedded sections appears to be the treatment of choice in such cases, particularly for recurrent lesions or lesions with poorly defined borders or possible subclinical extension.
authors.affiliation: Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, Spain.
authors.forename: H
authors.initials: H
authors.lastname: Hilari
authors.forename: D
authors.initials: D
authors.lastname: Llorca
authors.forename: V
authors.initials: V
authors.lastname: Traves
authors.forename: A
authors.initials: A
authors.lastname: Villanueva
authors.forename: C
authors.initials: C
authors.lastname: Serra-Guillén
authors.forename: C
authors.initials: C
authors.lastname: Requena
authors.forename: B
authors.initials: B
authors.lastname: Llombart
authors.forename: O
authors.initials: O
authors.lastname: Sanmartín
authors.forename: C
authors.initials: C
authors.lastname: Guillén
authors.forename: E
authors.initials: E
authors.lastname: Nagore
mesh_terms: D000368:Aged; D000634:Aminoquinolines / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D006801:Humans; D018327:Hutchinson's Melanotic Freckle / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D000077271:Imiquimod; D008297:Male; D008875:Middle Aged; D015580:Mohs Surgery / Q000379:methods*; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000517:prevention & control / Q000601:surgery; D018365:Neoplasm, Residual; D016612:Paraffin Embedding; D012086:Reoperation; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D012880:Skin Pigmentation; D016896:Treatment Outcome
chemical_list: D000634:Aminoquinolines; D000970:Antineoplastic Agents; D000077271:Imiquimod