Ultraviolet-Assisted Punch Biopsy Mapping for Lentigo Maligna Melanoma

Abstract

Lentigo maligna melanoma (LMM) accounts for a substantial incidence of all locally recurrent melanoma. In addition, the head and neck area accounts for 60% to 90% of all LMMs, which has important functional and cosmetic implications. The difficulty in the identification of the true borders of LMM may account for the high incidence of local recurrence. The purpose of this study was to evaluate the efficacy of ultraviolet-assisted punch biopsy mapping to identify clear margins using identified, 2-mm circumferentially arranged punch biopsies at the junction of the pigmented and nonpigmented borders. A retrospective chart review of 20 patients with biopsy-confirmed LMM of the head and neck was performed. Using ultraviolet identification, 2-mm circumferentially arranged biopsy specimens were obtained and sent for formal pathological review, including immunohistochemical staining. The average time for completion of pathological review was 5 to 7 days. If the punch biopsies were positive for lentigo maligna or LMM, punch biopsies were obtained more peripherally. Once clear, margins were obtained and definitive resection was performed. Twenty patients with biopsy-proved LMM were evaluated. Follow-up ranged from 6 months to 3 years (mean follow-up, 1 year). Fourteen patients were cleared after their first series of biopsies, 3 patients required a second series of biopsies, 2 patients required a third session, and 1 patient required a fourth biopsy session. To date, there has been no evidence of recurrence. No patients required reexcision for positive surgical margins. One complication has been local cellulitis of a punch biopsy site requiring a short course of antibiotics. Ultraviolet-assisted punch biopsy mapping of LMM is a safe, well-tolerated, and accurate technique for identifying the true histological margin of LMM. The procedure reduces the need for repeat surgical excisions to obtain clear margins and may decrease the risk for recurrence by mapping accurately the true histological margin.

Mapping biopsy with punch biopsies to determine surgical margin in extramammary Paget's disease

“…Mapping biopsy is a preoperative method to identify the histological margin in order to avoid unnecessary radical surgical resection and reduce the recurrence rate. The procedure has various terms, such as punch biopsy mapping, multiple scouting biopsies and skin mapping with punch biopsies . Mapping biopsy has been advocated for many tumors that have an unpredictable amount of subclinical spread, such as perianal Bowen's disease, lentigo maligna melanoma and EMPD.…”

Grenz ray treatment of lentigo maligna and early lentigo maligna melanoma

“…Here, Woods light examination can aid in defining the clinical borders. 38,39 Residual dermal pigmentation, incontinence of pigment, can be seen up to 3 to 6 months after radiation. Reactive hyperpigmentation, depending on the skin phenotype and ultraviolet exposure, can be difficult to distinguish from activity in the previous LM, and we recommend generous histological investigation.…”

Skin Mapping With Punch Biopsies for Defining Margins in Melanoma: When You Don’t Know How Far to Go

“…These include systemic and local therapies 1,8–10. High-dose interferon alfa is the only approved adjuvant treatment for melanoma; however, it has not been evaluated for local control of radial growth phase melanoma and has clinically important morbidity 11–15.…”

“…Use of punch biopsies for mapping melanoma in combination with ultraviolet (UV) imaging has been reported previously 1. The UV light permits identification of melanin in the dermal layer and preliminarily suggests the border of the melanocytic lesion.…”

“…Nonclassical presentations of cutaneous melanoma, however, continue to challenge the physician and may not fit into the typical management algorithm. This is especially the case when the radial growth phase component of the melanoma is nonpigmented and not clinically evident 1. Occasionally, the radial growth phase component of a melanoma may extend well beyond the visible extent of the melanoma.…”