In vivo reflectance confocal microscopy to optimize the spaghetti technique for defining surgical margins of lentigo maligna.
BACKGROUND
Lentigo maligna (LM) is a therapeutic challenge for surgeons because of its location in aesthetic areas and the difficulty in determining margins.


OBJECTIVE
To investigate a new procedure combining the "spaghetti" technique described by Gaudy-Marqueste and colleagues in 2011 with in vivo reflectance confocal microscopy (RCM) to define the margins of LM more accurately and allow strict histologic control.


METHODS
Thirty-three consecutive patients with LM of the head underwent a RCM-guided delineation of the margins followed by the "spaghetti" technique.


RESULTS
The excision of the first "spaghetti" in a tumor-free area was obtained in 28 of 33 patients. In the other five cases, persistence of LM foci was found in <5% of the length of spaghetti. The average number of pieces of "spaghetti" was 1.2 (range 1-3). Definitive histologic examination of the lesion showed a minimum average margin of 2.7 mm. Follow-up in 27 patients after an average of 10 months (range 4-25 months) did not show any recurrence.


CONCLUSIONS
This procedure allows accurate definition of the surgical margins of LM, with a low rate of multiple excisions, sparing tissue in functional and aesthetic areas. These results should be confirmed on the basis of a larger series with longer follow-up.
Department of Maxillofacial and Plastic Surgery, University Hospital of Saint Étienne, Saint-Étienne, France; Faculty of Medicine, University of Saint-Étienne, Saint-Étienne, France.
Julie
J
Champin
Jean-Luc
JL
Perrot
Elisa
E
Cinotti
Bruno
B
Labeille
Catherine
C
Douchet
Grégory
G
Parrau
Frédéric
F
Cambazard
Pierre
P
Seguin
Thomas
T
Alix
D000368:Aged; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D018327:Hutchinson's Melanotic Freckle / Q000473:pathology* / Q000601:surgery*; D008297:Male; D018613:Microscopy, Confocal / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome