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

Abstract

Introduction Lentigo maligna (LM) is melanoma in situ on sun-damaged skin and presents diagnostic challenges due to overlapping features with benign pigmented lesions. Cosmetic treatments may be inadvertently performed on LM. The aim of this study is to estimate the prevalence of LM with prior cosmetic treatment, and evaluate surgical outcomes. Study Design and Methods Retrospective review of biopsy-proven LM presenting over a ten-year period (2006–2015). Prior cosmetic treatment and biopsies were recorded. Records were reviewed for demographic data, clinical characteristics, and surgical outcomes. Results 37/503 (7.4%) patients with LM reported prior cosmetic therapy. Most (95%) were on the head and neck; mean size 1.9 centimeters. Most patients reported cryotherapy (73%), followed by laser (29.7%), topical bleaching agents (18.9%), and electrodessication and/or curettage (5.3%). Ten patients (27%) received two or more modalities. Eight patients (21.6%) reported prior benign biopsies. Six patients (16%) had invasive disease, two on initial biopsy and 4/34 (11.7%) upstaged upon excision. Average margin for clearance was 9.1 millimeters. Conclusion Prior cosmetic treatment of LM is not uncommon, and may delay diagnosis and obscure borders, resulting in wider surgical margins. Clinicians should consider a biopsy confirming the benign nature of equivocal lesions prior to cosmetic treatment.

The use of 2940‐nm ER:YAG laser for the treatment of lentigo maligna

“…Little information and few high-quality studies are available on this topic. There is also an ongoing assumption that the incidence of residual or recurrent tumors is higher following non-surgical procedures [ 19 ] . A recent literature review by Read et al demonstrated mean recurrence rates of 11.5 % for radiotherapy, 24.5 % for topical imiquimod and 34.4 % for lasers after the treatment of lentigo maligna [ 20 ] .…”

Desmoplastic Melanoma Arising after 1,064 nm q-Switched Nd:YAG Laser of a Suspected Solar Lentigo

“…When considering the possibility of misdiagnosis, we must consider the broad differential diagnosis of solar lentigines, which includes early seborrheic keratoses, pigmented actinic keratoses, and benign melanocytic nevi, as well as lentigo maligna (LM), a type of melanoma in situ [2]. As solar lentigines are a clinical diagnosis with a wide differential, whose definition may vary between physicians, it is logical that a variety of cosmetic treatments may be performed on these lesions [5]. Several reports have documented LM arising after laser therapies to a pigmented lesion [2, 5, 6].…”

Einsatz des 2940 nm ER:YAG‐Lasers zur Behandlung der Lentigo maligna

“…Zu diesem Thema stehen kaum Informationen und nur wenige qualitativ hochwertige Studien zur Verfügung. Es besteht nach wie vor die Vermutung, dass die Inzidenz residualer oder rezidivierender Tumoren nach nichtchirurgischen Verfahren höher ist . Eine kürzliche Literaturübersicht von Read et al.…”