Surgical reconstruction of lentigo maligna defects

To review our experience with lentigo maligna, a melanoma in situ that occurs primarily on the head and neck in older adults, and reconstructive efforts applied in managing the large defects following lentigo maligna excision that are not amenable to primary closure.

We reviewed the records of 23 patients who underwent serial excision of lentigo maligna using a modified Mohs technique. We compared the sizes of the initial lesion and postexcision defect, examined photographs taken before and after surgery, and studied techniques used in reconstruction.

The final surgical defect after staged Mohs excision of lentigo maligna lesions ranged from 2 to 10 times the original lesion size. Invasive melanoma was identified in 2 surgical specimens on pathologic evaluation. We reviewed successful reconstructive techniques including local flaps and tissue expansion.

Surgical excision remains the standard of care for lentigo maligna. Because of the subclinical spread and extensive radial growth characteristic of these lesions, patients are often left with large defects that are not amenable to primary closure. Appropriate preoperative patient counseling includes preparation for the possibility of a large surgical defect that requires staged reconstruction. Creative techniques, including local flaps and tissue expansion, must be in the head and neck reconstructive surgeon's armamentarium for the management of defects following lentigo maligna excision.