Usefulness of the staged excision for lentigo maligna and lentigo maligna melanoma: The “square” procedure

Use of Digital Epiluminescence Microscopy to Help Define the Edge of Lentigo Maligna

“…The subclinical extension of atypical junctional melanocytic hyperplasia away from the LM makes the boundary of the lesion difficult to identify. 3,4 Since dermoscopy increases the diagnostic accuracy of the clinician, it was hypothesized that it might enhance determination of the edge of the process. A technique that improves the surgeon's ability to identify the edge of the lesion would be beneficial because complete surgical excision may be achieved with less need for reexcision.…”

Surgical Tip: The Double-Bladed Scalpel in Mohs Micrographic Surgery

“…Up to 16 parallel blades have been placed on a single knife for this purpose 4 . The double-bladed scalpel has been employed for scar removal 5 , staged excision of lentigo maligna melanoma with permanent vertical section margin control 6 and excision of small basal cell carcinoma 7,8 . To get full analysis of the margin of tumor, the surgeon must perform some type of "en face" resection of the margin, meaning that the entire peripheral margin must be excised and examined.…”

Melanoma

“…Various approaches, all aimed at complete surgical excision with meticulous margin control, have shown high local control rates and are used at some NCCN centers, although they are not universally accepted. 42,43 NCCN Recommendations: The NCCN recommendations for surgical margins for wide excision are based on the results of clinical trials discussed earlier.…”