title: Improving management and patient care in lentigo maligna by mapping with in vivo confocal microscopy.
abstract: OBJECTIVE
  Lentigo maligna (LM) is a clinical, pathologic, and therapeutic challenge with a higher risk of local recurrence than other types of melanoma correctly treated and also carries the cosmetically sensitive localization of head and neck.
  
  
  OBJECTIVE
  To determine whether in vivo reflectance confocal microscopy (RCM) mapping of difficult LM cases might alter patient care and management.
  
  
  METHODS
  Analysis of LM and LM melanoma (LMM) in a series of patients with large facial lesions requiring complex reconstructive surgery and/or recurrent or poorly delineated lesions at any body sites were investigated.
  
  
  METHODS
  Two tertiary referral melanoma centers in Sydney, Australia.
  
  
  METHODS
  Thirty-seven patients with LM (including 5 with LMM) were mapped with RCM. Fifteen patients had a recurrent LM, including 9 with multiple prior recurrences. The LM was classified amelanotic in 10 patients, lightly pigmented in 9, and partially pigmented in 18.
  
  
  METHODS
  The RCM images were obtained in 4 radial directions (allowing for anatomic barriers) for LM margin delineation using an RCM LM score previously described by our research team.
  
  
  METHODS
  Differences in the margin of LM as determined by RCM vs dermoscopy vs histopathologic analysis.
  
  
  RESULTS
  Seventeen of 29 patients (59%) with dermoscopically visible lesions had subclinical (RCM-identified) disease evident more than 5 mm beyond the dermoscopy margin (ie, beyond the excision margin recommended in published guidelines). The RCM mapping changed the management in 27 patients (73%): 11 patients had a major change in their surgical procedure, and 16 were offered radiotherapy or imiquimod treatment as a consequence of the RCM findings. Treatment was surgical in 17 of 37 patients. Surgical excision margins (based on the RCM mapping) were histopathologically involved in only 2 patients, each of whom had an LM lesion larger than 6 cm.
  
  
  CONCLUSIONS
  In vivo RCM can provide valuable information facilitating optimal patient care management.
authors.affiliation: Melanoma Institute Australia, The University of Sydney, Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050, Australia. pascale.guitera@melanoma.org.au
authors.forename: Pascale
authors.initials: P
authors.lastname: Guitera
authors.forename: Fergal J
authors.initials: FJ
authors.lastname: Moloney
authors.forename: Scott W
authors.initials: SW
authors.lastname: Menzies
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Stretch
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Quinn
authors.forename: Angela
authors.initials: A
authors.lastname: Hong
authors.forename: Gerald
authors.initials: G
authors.lastname: Fogarty
authors.forename: Richard A
authors.initials: RA
authors.lastname: Scolyer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D046169:Dermoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D018327:Hutchinson's Melanotic Freckle / Q000473:pathology / Q000628:therapy*; D008297:Male; D018613:Microscopy, Confocal / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology / Q000628:therapy*