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PubMed1994

Successful treatment of lentigo maligna and lentigo maligna melanoma with Mohs' micrographic surgery aided by rush permanent sections.

BACKGROUND: Lentigo maligna (LM) is a pigmented neoplasm on sun-exposed skin of elderly patients. LM slowly increases in size and may become lentigo maligna melanoma (LMM), a potentially fatal malignancy. Complete excision is the treatment of choice. Mohs' micrographic surgery (MMS) with frozen and permanent sections may be used for complete eradication of the lesion, while sparing as much normal tissue as possible. The authors studied the efficacy of MMS for the treatment of LM and LMM. METHODS: Between 1985 and 1992, 45 patients with LM (26) and LMM (19) were treated with MMS. The authors' technique was to use examination of frozen sections and rush permanent sections (prepared and read within 24 hours). Positive frozen sections warranted further excision. For negative or equivocal frozen sections, surgery was interrupted until the examination of permanent sections was performed. RESULTS: All 45 patients were free of local disease and evidence of metastases at an average of 29.2 months (range, 4-81 months) after therapy. CONCLUSIONS: MMS aided by rush permanent sections yielded a prolonged disease free survival for all 45 patients with LM or LMM. Because the MMS technique minimizes the removal of normal tissue, and the local cure rate in this study was superior to that reported for conventional surgery, the authors recommend this technique for the treatment of LM and LMM.

Adult↗
PubMed2004

Management of lentigo maligna and lentigo maligna melanoma: seminars in surgical oncology.

Lentigo maligna (LM) and lentigo maligna melanoma (LMM) represent a character, histogenetic subclass of melanocytic malignancies. They often present with a prolonged phase of slow growth but once invasion has occurred, the prognostic features are identical to all other melanomas. These lesions occur primarily on the head and neck where they evolve from areas of pigmented staining to the more typical features identifiable with malignant melanomas on other skin surfaces. The treatment options and recent advances in management are reviewed.

Adjuvants, Immunologic↗
PubMed1995

Lentigo maligna and lentigo maligna melanoma.

Lentigo maligna (LM) is a pigmented lesion that occurs on the sun-exposed skin, particularly the head and neck areas, of an older patient. The lesion increases in size and at some point, often many years after its onset, may become lentigo maligna melanoma (LMM). For this reason, most authors consider LM a form of melanoma in situ. Treatment includes surgical or destructive modalities; the preferred form of therapy is surgical removal. Histopathologic features include a proliferation of atypical melanocytes along the basal layer of the epidermis and adnexal structures. This article discusses the clinical, histopathologic, and epidemiologic features of LM. The prognosis and treatment of LM are reviewed. Although the lifetime risk of the development of LMM is unclear, LMM is discussed briefly.

Combined Modality Therapy↗
PubMed1983

Conventional fractionated radiotherapy for 51 patients with lentigo maligna and lentigo maligna melanoma.

Lentigo maligna (LM) and lentigo maligna melanoma (LMM) are distinct entities from other forms of melanoma, occurring predominantly on the skin of the head and neck in elderly people, having a slow growth rate and a low metastatic potential (10%). Twenty-three patients with LM were treated with conventional fractionated irradiation, 18 were locally controlled and two failed locally both of whom, however, were salvaged with further treatment. Three patients are not evaluable because of short follow-up time. Median time to complete regression of the lesion is seven months. Twenty-eight patients with LMM have been irradiated, 23 are locally controlled, two locally recurred (both retrieved with subsequent treatment), and three are inevaluable because of short follow-up time. One patient with a level 5 LMM has developed regional and distant metastases. It is concluded that irradiation is a simple effective method of treatment for this form of melanoma.

Adult↗
PubMed1982

Conventional radiotherapy in the treatment of lentigo maligna and lentigo maligna melanoma.

Forty cases of lentigo maligna (LM) and lentigo maligna melanoma (LMM) treated by conventional fractionated radiotherapy are reviewed. Fourteen of seventeen LM patients are alive and well 4 months to 5 years following irradiation, one patient died of intercurrent disease without recurrence, and two had residual or recurrent tumor (both salvaged by excision or further irradiation). Twenty-one of twenty-three LMM patients had their tumor controlled from 1 month to 7 years following irradiation. Two recurred locally or had residual tumor, and both were salvaged by excision. There have been no regional or distant recurrences of melanoma in the entire series. Cosmetic results of treatment are excellent. The lesions can take up to 24 months to disappear following irradiation. It is concluded that conventional fractionated radiotherapy is simple, effective outpatient treatment worthy of further study for LM and LMM.

Aged↗
PubMed1997

Usefulness of the staged excision for lentigo maligna and lentigo maligna melanoma: the "square" procedure.

BACKGROUND: Management of lentigo maligna (LM) and lentigo maligna melanoma (LMM) may present problems because of the characteristic, yet unpredictable, subclinical peripheral and periadnexal extension of atypical junctional melanocytic hyperplasia beyond the visible margins. OBJECTIVE: We used paraffin-embedded (permanent) peripheral vertical section margin control in a staged fashion in the management of LM and LMM. METHODS: We used a modification of surgical excision in a staged fashion by means of a two-bladed knife with permanent peripheral vertical section margin control. RESULTS: This method is technically easy and results in complete histologic evaluation of the peripheral margins without compromising the measurement of tumor thickness of the primary melanoma. CONCLUSION: The use of the "square" procedure, a staged excision with permanent peripheral vertical section margin control, is useful in the management of LM and LMM.

Biopsy↗
PubMed2002

A retrospective study of 150 patients with lentigo maligna and lentigo maligna melanoma and the efficacy of radiotherapy using Grenz or soft X-rays.

BACKGROUND: Lentigo maligna (LM) and lentigo maligna melanoma (LMM) are the most common melanocytic neoplasms on sun-exposed skin of elderly patients. OBJECTIVES: To perform a retrospective study of 150 patients with LM and LMM treated with radiotherapy using Grenz or soft X-rays. METHODS: The information recorded and analysed included gender, age, diagnosis, size of the lesion, localization, X-ray treatment, recurrence rate, other skin malignancies and non-dermatological neoplasms. RESULTS: The 150 patients comprised 78 women and 72 men (mean age 70 years). Ninety-three patients had LM, 54 had LMM and three had both neoplasms. Ninety per cent of lesions were located on the face. Treatment was with Grenz rays in 96 patients with LM and 11 with LMM (70%) and with soft X-rays in 46 patients with LMM (30%). Three patients were treated using both modalities. One hundred and one patients were followed up for at least 2 years after radiotherapy (mean 8 years). The mean time to recurrence was 45.6 months, and the recurrence rate was 7% (seven of 101). Other skin malignancies were observed in 65 of 150 patients, including basal cell carcinoma in 23 (35%) and actinic keratosis in 20 (31%). Four patients developed internal cancers. CONCLUSIONS: The study showed that radiotherapy of LM and LMM was curative. In particular, radiotherapy proved to be an excellent treatment for elderly patients. Owing to the high incidence of other skin cancers, LM patients need careful follow-up.

Adult↗
PubMed1999

Surgical treatment of lentigo maligna and lentigo maligna melanoma.

Lentigo maligna (LM) is well known as an irregularly pigmented macular lesion usually presenting on the sun-damaged head and neck of older patients. Lentigo maligna (LM) has the potential to develop into invasive melanoma (LMM). A method of surgical excision for the treatment of LM and LMM using paraffin sections with tissue mapping to ensure clear margins before delayed defect closure is described. The results of applying this method in the treatment of 66 cases over a 40 month period are presented. Thirty-eight per cent of cases required two excisions or more to clear the tumour and 32% of cases showed evidence of invasive melanoma. Only one case has recurred thus far, and none have developed metastatic disease.

Adult↗
PubMed2000

Fractionated radiotherapy of lentigo maligna and lentigo maligna melanoma in 64 patients.

Between 1987 and 1998, 64 patients with lentigo maligna (LM) (n = 42) or lentigo maligna melanoma (LMM) (n = 22) were treated by fractionated radiotherapy. In all 22 patients with LMM, excision of the nodular part of the LMM was performed before radiation of the residual lentiginous tumor. During the follow-up period of 1 to 96 months (mean, 23 months; median, 15 months), none of the 42 patients with LM displayed any signs of recurrence of LM after radiation therapy alone. Of the 22 patients with LMM, only 2 patients showed local recurrence of the tumor, salvaged by excision in both cases. One patient with LMM suffered from metastatic disease without local recurrence of the melanoma 44 months after radiation therapy. The cosmetic results of radiotherapy were good or excellent in the vast majority of patients, with only a few experiencing hypopigmentation or hyperpigmentation in the irradiated area. Fractionated radiation therapy with superficial x-rays is an effective method of treatment of LM associated with low morbidity and leading to clinical results comparable to those of surgical excision.

Aged↗
PubMed1998

Mohs micrographic surgery for lentigo maligna and lentigo maligna melanoma. A follow-up study.

BACKGROUND: We previously reported our experience using Mohs micrographic surgery (MMS) for 45 patients with lentigo maligna (LM) and lentigo maligna melanoma (LMM). The patients were treated between 1985 and 1992. In our initial publication, all of the patients were free of local disease and evidence of metastases at an average of 29.2 months after therapy. OBJECTIVE: The purpose of this study was to report long-term follow-up of our previously published data. METHODS: MMS was performed in 26 patients with LM and 19 patients with LMM using frozen sections followed by rush permanent sections. Follow-up was obtained by contacting the referring physician, examination by one of our two Mohs surgeons, or by contacting the patient or his or her family. RESULTS: After a median follow-up of 58.0 months (214.3 patient-years), there was one recurrence. This patient was a 56-year-old woman with five prior recurrences before MMS. Six patients were decreased of other causes during the study. CONCLUSIONS: MMS using frozen and rush permanent sections resulted in a 97% cure rate for LM and LMM. Because MMS minimizes the removal of normal tissue, and the cure rate exceeds that of conventional therapies, the authors recommend this technique for the treatment of LM and LMM.

Adult↗
PubMed2006

Mohs micrographic surgery for lentigo maligna and lentigo maligna melanoma using Mel-5 immunostaining: University of Minnesota experience.

BACKGROUND: Mohs micrographic surgery (MMS) continues to become a more common and accepted treatment for lentigo maligna (LM) and lentigo maligna melanoma (LMM). The primary difficulty encountered lies in the accurate identification of atypical single melanocytes to determine tumor-free margins. Numerous methods have been used to better visualize single melanocytes, with varying results. We present our experience using Mel-5 immunostaining in MMS of LM and LMM. METHODS: Two hundred patients with primary or recurrent LM or LMM were treated using MMS from 1999 to 2003 at the University of Minnesota. The initial clinical margins were determined by Wood's light examination, and an initial debulk specimen was taken and sent for formalin fixation and later reviewed by a dermatopathologist. The first Mohs layer was then taken, and staining with hemotoxylin and eosin as well as Mel-5 immunostaining was performed. All patients were followed up to evaluate for recurrence, with a mean follow-up time of 38.4 months. RESULTS: Of the 200 patients treated, only one recurrence was noted. This patient had been treated with excision followed by radiation before MMS. Use of Mel-5 immunostaining added approximately 40 minutes to each stage. Use of the Autostainer Immunostaining System (DAKO, Carpenterina, CA, USA) shortened the added time to 20 minutes. CONCLUSIONS: MMS with Mel-5 immunostaining yielded excellent results in the treatment of LM and LMM, with only one recurrence noted in 200 patients. When an automated immunostainer was used, minimal time was added to each Mohs stage.

Adult↗
PubMed2003

Mapped serial excision for periocular lentigo maligna and lentigo maligna melanoma.

PURPOSE: To report the early cure rate for periocular lentigo maligna (LM) and LM melanoma (LMM), using modified Mohs surgery with vertically cut paraffin-embedded sections (mapped serial excision [MSE]). A secondary aim was to identify differences in the clinical features and outcomes between periocular LM and LMM and those found elsewhere on the head and neck. DESIGN: Prospective, noncomparative, interventional case series. PARTICIPANTS: One hundred thirty-five patients undergoing 141 MSE procedures. METHODS: A prospective series of 141 MSE procedures for LM and LMM over a 10-year period (1993-2002) in a single-center Mohs surgical unit. MAIN OUTCOME MEASURES: Recurrence, site, size of LM or LMM, invasiveness, prior recurrence, clear margin of excision, size of final defect, and number of levels required for complete excision. RESULTS: One hundred forty-one MSE procedures, of which 23% (32/141) were for LMM and 19% (27/141) were for periocular lesions. Location or prior recurrence were not predictive of invasive disease; however, the size distribution of the initial lesion (P = 0.0354) and the final defect after MSE (P = 0.0183) were larger in LMM. Thirty-one percent of LM and 14% of LMM less than 1 mm thick required larger than 5-mm and 1-cm margins, respectively, for complete excision. Mean follow-up of 32 months (range, 1-100 months) revealed 4 recurrences (3%), of which two were periocular (P = 0.188). CONCLUSIONS: Our review is the largest prospective series of MSE for LM and LMM and suggests that it is the treatment of choice in these forms of melanoma. Mapped serial excision offers a high early cure rate in conjunction with tissue conservation, which is of particular relevance in the periocular region. There were no significant differences between periocular LM and LMM and those found elsewhere in the head and neck region. It also appears that the current recommendations of 5-mm margins for in situ melanoma (LM) and 1-cm margins for melanoma less than 1 mm thick are insufficient for complete excision of LM or LMM, emphasizing the importance of margin-controlled excision of these lesions.

Adult↗
PubMed1998

Extrafacial lentigo maligna melanoma: analysis of 71 cases and comparison with lentigo maligna melanoma of the head and neck.

We report a retrospective analysis of extrafacial lentigo maligna melanoma (LMM), and a comparison with patients with LMM of the head and neck. Seventy-one patients (22 men, 49 women) with extrafacial LMM were identified from the Scottish Melanoma Group database for January 1979-March 1996. Their mean age (63 years) was significantly less than that of 335 patients with head and neck LMM (mean 72 years, P < 0.001), with a significantly greater difference among women than men. Extrafacial sites comprised 17.5% of LMMs. There was a marked body site distribution difference between the sexes (P = 0. 001): 68% of extrafacial LMMs in men were on the trunk while 80% in women were on the limbs, particularly the lower leg. Extrafacial LMMs were thinner at presentation than head and neck LMMs (P < 0.05) in both sexes, but this was not simply explained by the younger age of these patients as there was no significant correlation between age and tumour thickness at either extrafacial or at head and neck sites. Although the female lower leg is a site of chronic solar exposure in older women, the other extrafacial sites are habitually covered in the temperate Scottish climate. The significantly younger age group of patients with LMM at extrafacial compared with head and neck sites therefore suggests that the relationship between LMM and sunlight is not simply related to cumulative solar exposure. The demonstration that head and neck LMMs were thicker at presentation compared with extrafacial sites, despite being at a more routinely visible part of the body, suggests that there are still opportunities for targeted pigmented lesion public education.

Age Factors↗