Surgical margin mapping for lentigo maligna and lentigo maligna melanoma: traditional technique (visual inspection with dermoscopy) versus combined paper tape and reflectance confocal microscopy technique

Abstract

Background The detection of subclinical margin in lentigo maligna/lentigo maligna melanoma (LM/LMM) can be challenging for the dermatologist. Reflectance confocal microscopy (RCM) enables to observe in vivo atypical melanocytes beyond the clinical margins. The aim of this study is to establish which of these methods (clinical examination and dermoscopy versus “Paper tape – RCM”) is more precise to define the lesion margin and to reduce the number of re‐intervention and overtreatments in cosmetically sensitive areas. Methods Fifty‐seven cases of LM/LMM were analyzed during 2016–2022. Pre‐surgical mapping procedures in 32 lesions were effectuated with dermatoscopy. Furthermore, pre‐surgical mapping procedures in 25 lesions were effectuated with RCM and paper tape. Results RCM method's accuracy to detect subclinical margins was 92.0%. In 24 of 25 cases, the lesions were excised completely during the first intervention. In 20 of 32 cases analyzed with dermoscopy, a second surgical intervention was effectuated. Conclusion The RCM paper method allows us to delineate subclinical margin more accurately and reduce overtreatment, especially in sensitive areas, such as the face and neck.

Lentigo Maligna Treatment—An Update

“…In the last few years, reflectance confocal microscopy (RCM), a non-invasive imaging technique that proved to be more sensitive and specific than dermoscopy in the diagnosis of LM, was studied in detecting the margins and reducing the risk of positive margins. Studies showed that RCM reduces the rate of positive histological margins, reduces the number of necessary stages, leading to less local recurrences [18,26,27]. When margin-controlled surgery is not available, RCM is associated with a better demarcation of the lesion, avoiding incomplete excision.…”

“…When margin-controlled surgery is not available, RCM is associated with a better demarcation of the lesion, avoiding incomplete excision. Moreover, even when margin-controlled surgery is available, the use of RCM leads to more precise and efficient surgical management of the lesion [18,26,27].…”