Utility of Wood's Light in Margin Determination of Melanoma In Situ After Excisional Biopsy

Walsh, Stephanie B.; Varma, Rajat; Raimer, David; Keane, James Cooper; Cantor, Alan; Theos, Amy; Northington, Marian; Huang, Conway C.

doi:10.1097/dss.0000000000000345

Cited by 16 publications

(10 citation statements)

References 14 publications

(9 reference statements)

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“…To overcome variation in margin estimation due to wound retraction after electrocoagulation, specimen shrinkage after formalin fixation, 29 or inaccuracy in the digital margin calculation, we performed 2 methods of image calibration, margin estimation, and videomosaic quadrant size estimation, which have not been described in previous studies assessing the LM/LMM margins. 7,8,14,15 However, further studies involving multiple readers with varying levels of experience are needed to validate these results, since our study included only two confocalists who acquired data and one who analyzed the results.…”

Section: Discussionmentioning

confidence: 99%

Correlation of Handheld Reflectance Confocal Microscopy With Radial Video Mosaicing for Margin Mapping of Lentigo Maligna and Lentigo Maligna Melanoma

et al. 2017

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IMPORTANCEThe management of lentigo maligna (LM) and LM melanoma (LMM) is challenging because of extensive subclinical spread and its occurrence on cosmetically sensitive areas. Reflectance confocal microscopy (RCM) improves diagnostic accuracy for LM and LMM and can be used to delineate their margins.OBJECTIVES To evaluate whether handheld RCM with radial video mosaicing (HRCM-RV) offers accurate presurgical assessment of LM and LMM margins. DESIGN, SETTING, AND PARTICIPANTSThis prospective study included consecutive patients with biopsy-proven LM and LMM located on the head and neck area who sought consultation for surgical management from March 1, 2016, through March 31, 2017, at the Dermatology Service of the Memorial Sloan Kettering Cancer Center. Thirty-two patients underwent imaging using HRCM-RV, and 22 patients with 23 LM or LMM lesions underwent staged surgery and contributed to the analysis. MAIN OUTCOMES AND MEASURESClinical lesion size and area, LM and LMM area based on HRCM-RV findings, surgical defect area estimated by HRCM-RV, and observed surgical defect area. In addition, the margins measured in millimeters estimated for tumor clearance in each quadrant based on HRCM-RV findings were calculated and compared with the surgical margins. RESULTS Among the 22 patients (12 men and 10 women; mean [SD] age, 69.0 [8.6] years [range, 46-83 years]) with 23 lesions included in the final analysis, the mean (SD) surgical defect area estimated with HRCM-RV was 6.34 (4.02) cm 2 and the mean (SD) area of surgical excision with clear margins was 7.74 (5.28) cm 2 . Overall, controlling for patient age and previous surgery, surgical margins were a mean of 0.76 mm (95% CI, 0.67-0.84 mm; P < .001) larger than the HRCM-RV estimate.CONCLUSIONS AND RELEVANCE Mapping of LM and LMM with HRCM-RV estimated defects that were similar to but slightly smaller than those found in staged excision. Thus, mapping of LM using HRCM-RV can help spare healthy tissue by reducing the number of biopsies needed in clinically uncertain areas and may be used to plan treatment of LM and LMM and counsel patients appropriately.

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Section: Discussionmentioning

confidence: 99%

Correlation of Handheld Reflectance Confocal Microscopy With Radial Video Mosaicing for Margin Mapping of Lentigo Maligna and Lentigo Maligna Melanoma

et al. 2017

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“…28 Wood's light examination has been demonstrated to be useful for margin assessment of melanoma in situ (MIS) before biopsy, 29 and is particularly useful in determining margins of LM/LMM before surgical excision. 30,31 However, Walsh et al 30 prospectively studied the accuracy of preoperative Wood's light examination for margin assessment of MIS after excisional biopsy. They concluded that it is not reliable to assess subclinical disease with Wood's light in these patients since many false positive and false negatives can occur.…”

Section: Wood's Lampmentioning

confidence: 99%

<p>Lentigo Maligna: Clinical Presentation and Appropriate Management</p>

Iznardo¹,

Garcia‐Melendo²,

Yélamos³

2020

CCID

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“…The literature states that the surgical borders of LMM can be determined more easily using Wood's light since there is a rise in epidermal melanin in the lesions. Wood's light, on the other hand, was found to detect lesions that could not be seen by the naked eye in just 11.7% of cases in a prospective study [ 45 , 46 ]. Walsh et al [ 46 ] investigated the precision of preoperative Wood's light test for melanoma in situ margin assessment after excisional biopsy in a prospective study.…”

Section: Noninvasive Proceduresmentioning

confidence: 99%

“…Wood's light, on the other hand, was found to detect lesions that could not be seen by the naked eye in just 11.7% of cases in a prospective study [ 45 , 46 ]. Walsh et al [ 46 ] investigated the precision of preoperative Wood's light test for melanoma in situ margin assessment after excisional biopsy in a prospective study. They concluded that using Wood's light to evaluate subclinical disease in these patients is ineffective due to the high rate of false positives and negatives.…”

Section: Noninvasive Proceduresmentioning

confidence: 99%

Diagnosis and Management of Lentigo Maligna: Clinical Presentation and Comprehensive Review

Naik¹

2021

Journal of Skin Cancer

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Lentigo maligna (LM), also known as Hutchinson’s melanotic freckle, is a form of in situ melanoma characterized by the proliferation of atypical melanocytes along the basal epidermis in sun-damaged skin. If left untreated, LM will progress to lentigo maligna melanoma (LMM), a form of invasive melanoma with the same prognosis as other forms of invasive melanoma. LM is more common in the elderly, with a peak occurrence between the ages of 65 and 80 years. LM, however, is rarely present on the trunk and extremities. The diagnosis of LM, confirmed by histopathological and biopsy examination, is based on clinical and dermoscopic features. It typically begins as a tan-brown macule or patch, but it can progress to a variegated pigmentation with dark black color or even amelanotic characteristics. The risk factors involved in the LM development include a history of sunburns, lighter skin types, advanced age, history of nonmelanoma skin cancers, and tendency to form solar lentigines. This article explains the clinical presentation of LM, also reviews the available information on the diagnosis and management of LM, and discusses the potential of such information in facilitating the future prospective.

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Utility of Wood's Light in Margin Determination of Melanoma In Situ After Excisional Biopsy

Cited by 16 publications

References 14 publications

Correlation of Handheld Reflectance Confocal Microscopy With Radial Video Mosaicing for Margin Mapping of Lentigo Maligna and Lentigo Maligna Melanoma

Correlation of Handheld Reflectance Confocal Microscopy With Radial Video Mosaicing for Margin Mapping of Lentigo Maligna and Lentigo Maligna Melanoma

<p>Lentigo Maligna: Clinical Presentation and Appropriate Management</p>

Diagnosis and Management of Lentigo Maligna: Clinical Presentation and Comprehensive Review

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