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Related Experiment Videos

Histologic evaluation of lentigo maligna with permanent sections: implications regarding current guidelines.

Neera Agarwal-Antal1, Glen M Bowen, John W Gerwels

  • 1Department of Dermatology, University of Utah, Salt Lake City, UT 84132, USA.

Journal of the American Academy of Dermatology
|October 26, 2002
PubMed
Summary

Standard 5-mm margins are insufficient for lentigo maligna (LM) removal in over half of cases. Polygonal, staged excisions with serial histopathology are crucial for achieving tumor-free margins in this challenging melanoma subtype.

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Area of Science:

  • Dermatology
  • Surgical Oncology
  • Pathology

Background:

  • Lentigo maligna (LM), a melanoma in situ subtype, presents surgical challenges for clear margin resection on sun-damaged skin.
  • Clinically and histologically uncertain margins complicate the determination of the surgical excision perimeter for LM.

Purpose of the Study:

  • To assess the adequacy of the 5-mm margin recommendation for LM removal.
  • To evaluate the number of staged excisions required to achieve tumor-free margins using polygonal resections.

Main Methods:

  • Ninety-two cases of LM were treated with staged, straight-edge polygonal resections.
  • Each resection stage utilized 5-mm margins, with specimens color-coded and mapped.
  • Serial histopathologic sections identified positive margins or atypical melanocytes for further resection until clear margins were attained.

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Main Results:

  • 42% of patients achieved tumor-free margins after one 5-mm stage, while 58% required two or more stages.
  • An invasive component was identified in the central portion of excisions in 16% of cases.
  • The median patient age was 70 years, with 75% of LM cases involving the head and neck.

Conclusions:

  • Polygonal perimeter excisions with serial histopathology in a staged manner are effective for LM evaluation and treatment.
  • The standard 5-mm margin is inadequate in over 50% of LM cases, highlighting the need for careful peripheral margin assessment.
  • Complete tumor submission at the first stage is recommended due to the potential presence of an invasive component.