Management of Lentigo Maligna and Lentigo Maligna Melanoma With Staged Excision

Bub, Jennifer L.; Berg, Daniel; Slee, April; Odland, Peter B.

doi:10.1001/archderm.140.5.552

Cited by 165 publications

(152 citation statements)

References 30 publications

(51 reference statements)

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“…In our report, 6 of the 11 cases had clear margins after one stage with 2 mm strips excised outside of the initial 5 mm margin. The remaining five cases required 2-4 stages for clear margins and two cases required four stages, lending credence to the view that NIH-recommended margins may not be sufficient for LM and LMM [9,15,24].…”

Section: Discussionmentioning

confidence: 71%

“…Out of 150 LM cases, only one short-term (<5 years) local recurrence has been reported using a similar staged excision technique [14]. In 62 lesions of LM and LMM, a 95% local control rate was reported at 5 years [24]. Mapped serial excision technique (MSE) is a related technique that has been used for periocular LM and LMM, with a reported 3% recurrence rate at 3 years [33].…”

Section: Discussionmentioning

confidence: 99%

“…Advantages over MMS include vertical sections, which are technically easier to process and interpret. Definitive flap reconstruction is facilitated with confirmation of tumor-free margins prior to repair, allowing preservation of function and aesthetics [13,14,24].…”

Section: Discussionmentioning

confidence: 99%

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The perimeter technique for lentigo maligna: an alternative to Mohs micrographic surgery

Mahoney¹,

Joseph²,

Temple³

2005

J. Surg. Oncol.

104

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Background: Lentigo maligna (LM) presents a challenge for complete surgical excision because of its extensive subclinical spread and predilection for the face. Objective: To report our experience using the staged perimeter technique as an alternative to Mohs micrographic surgery for treatment of LM. Methods: The perimeter procedure was performed on 11 patients with LM between March 2003 and June 2004. Data on patient and lesion characteristics, number of stages required to obtain clear margins, and follow-up was obtained by chart review. Results: A mean of 1.9 stages were required to achieve clear margins. A mean of 7 tissue specimens were sent to pathology per patient for evaluation. After a mean follow-up of 4.7 months, all patients were free of recurrence. Conclusions: The perimeter technique is a simple method of margin-controlled excision of LM. The main advantage is that all margins are examined with permanent sections. The main drawback is that multiple operative sessions are required to complete the procedure. This technique does not require specific Mohs training and is therefore applicable to non-Mohs surgeons.

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The perimeter technique for lentigo maligna: an alternative to Mohs micrographic surgery

Mahoney¹,

Joseph²,

Temple³

2005

J. Surg. Oncol.

104

View full text Add to dashboard Cite

show abstract

“…In contrast to surgical excision, MMS allows for the examination of 100% of the peripheral margins. Despite the advantages of MMS as a tissue-sparing procedure, controversy surrounds the use of frozen sections to identify malignant melanocytic cells (6). Pathological difficulties encountered include: vacuolated keratinocytes mimicking melanocytes, processing artifact, and dermal inflammatory cells that may obscure the melanocytes in frozen sections (7).…”

Section: Mohs Micrographic Surgerymentioning

confidence: 99%

Surgical Management of Melanoma

Joyce

2017

Cutaneous Melanoma: Etiology and Therapy

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This chapter discusses the surgical principles in the management of melanoma. Surgery remains the mainstay of treatment of primary melanoma, and in the majority of cases it is curative. Appropriate surgical management is critical for the diagnosis, staging, and optimal treatment of both in situ and invasive primary cutaneous melanoma. Surgical management is dependent on the stage of the disease, and therefore this chapter evaluates localized, regional, and metastatic disease. The concept of sentinel lymph node biopsy is discussed along with its benefits, pitfalls, and prognostic significance. Furthermore, several important surgical issues are discussed, including the extent of surgical margins, Mohs micrographic surgery for melanoma in situ, and the role of metastasectomy.

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“…For larger in situ cases and those of the lentigo maligna subtype, most CM surgeons aim for margins in the 5-to 10-mm range. 46,47 Palliation of symptoms is perhaps the surgeon's most important role in the local management of AM. Close to a quarter of patients reported in the series reviewed underwent surgery for palliative reasons.…”

Section: Managing the Tumor Sitementioning

confidence: 99%

Anorectal Melanoma: Diagnosis and Treatment

Meguerditchian¹,

Meterissian²,

Dunn

2011

Diseases of the Colon &Amp; Rectum

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An increase in the incidence of anorectal melanoma has recently been noted in the United States. Anorectal melanoma is an uncommon and lethal condition, with a median survival of <20 months. Unfortunately, nonspecific symptoms also attributable to common and benign conditions (eg, hemorrhoids) cause significant delay in its diagnosis. Although it has not been validated by clinical trials, abdominoperineal resection has historically been the treatment of choice for this disease. However, for the past 2 decades, a lack of clear survival benefit has led to a shift toward less-mutilating wide local excisions. Controversy still exists regarding the benefit of radiation therapy and chemotherapy. Furthermore, the value of nodal surgery in anorectal melanoma is unclear. In this article, we review the history and current status of management of anorectal melanoma, with a particular focus on surgical controversies and challenges in optimizing survival.

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Management of Lentigo Maligna and Lentigo Maligna Melanoma With Staged Excision

Cited by 165 publications

References 30 publications

The perimeter technique for lentigo maligna: an alternative to Mohs micrographic surgery

The perimeter technique for lentigo maligna: an alternative to Mohs micrographic surgery

Surgical Management of Melanoma

Anorectal Melanoma: Diagnosis and Treatment

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