Five-Year Outcomes of Wide Excision and Mohs Micrographic Surgery for Primary Lentigo Maligna in an Academic Practice Cohort

Abstract

This follow-up study of LM surgical treatments shows excellent outcomes for wide excision and MMS. Because this is a nonrandomized retrospective study, no direct comparisons between the 2 treatments can be made. When recurrences occurred, repeat surgery, either standard excision or MMS, was usually sufficient to provide definitive cure.

Effect of topical imiquimod as primary treatment for lentigo maligna: the LIMIT-1 study

“…Five per cent of patients with typical LM may actually have early invasive melanoma, and the risk of progression to invasive lentigo maligna melanoma (LMM) is poorly quantified . Reported outcomes following surgery vary, including a 30% probability of recurrence at 66–98 months and a 1·5% probability of transformation to LMM for 81 patients, a crude failure rate (recurrence plus incomplete excision) of eight of 102 following resection excision with 2‐mm margins, and crude recurrence rates of 16 of 269 (5·9%) following wide local excision and three of 154 (1·9%) following Mohs micrographic surgery . LM occurs most frequently on the head and neck, so surgery can cause significant functional and cosmetic disability and, in some cases, might not be feasible.…”

Lentigo maligna melanoma with a history of cosmetic treatment: Prevalence, surgical outcomes and considerations

“…As the incidence of LM/LMM continues to increase, providers must be aware of lesions not responding to conventional treatments, and be cautious of presumed benign pigmented lesions that deviate morphologically prior to treating cosmetically. The average age in our series (61) is lower than the reported 65-70 years [9][10][11][12], reflecting both the increased interest in cosmetic procedures among younger individuals and that the incidence of melanoma in situ is increasing, with a faster rate in younger populations [13]. Interestingly, nearly 50% of the patients in our series were male, which reflect current trends that more men are seeking cosmetic procedures [14].…”

“…Another limitation is that this was a single center study; however, this allowed for consistency in surgical technique, histopathologic evaluation, and margin determination. Comparison of our series to others was limited by heterogeneity of lesions included in the study, varying surgical technique, absence of reporting rates of invasion or surgical margins, and an unknown number of patients with prior cosmetic treatment included in other series [10][11][12]19,44].…”

Mohs micrographic surgery versus wide local excision for melanoma in situ: analysis of a nationwide database

“…However, there have been few published direct comparative studies between WLE and MMS techniques for surgical treatment of MIS. Hou et al reported data from 269 cases of primary lentigo maligna treated with wide excision compared with 154 cases treated with MMS. They reported similar local recurrence‐free survival rates between wide excision versus MMS techniques at 5‐, 10‐, and 15‐year follow‐up.…”

“…Survival rates at 5-, 10, and 15-year follow-up were similar between WLE versus MMS groups for MIS ( Low recurrence rates <2% have been reported in the use of MMS for MIS and melanoma in a number of studies. [11][12][13][14][15][16][17][18] which allows for tissue preservation. Given that maximal amount of normal skin is preserved and the smallest surgical defect possible is obtained with MMS, it should be considered when lesions are located in areas of anatomical and cosmetic significance.…”