Staged margin control techniques for surgical excision of lentigo maligna

Area of Science:

• Dermatology
• Surgical Oncology
• Pathology

Background:

• Melanoma in situ (MIS) on chronically photodamaged skin, known as lentigo maligna (LM), requires specialized treatment.
• Standard 5-mm excision margins for MIS are often inadequate for LM due to indistinct borders.

Purpose of the Study:

• To review and highlight specialized surgical techniques for LM treatment.
• To emphasize the importance of meticulous margin assessment in surgical excisions for LM.

Main Methods:

• Review of surgical techniques including staged margin control with frozen or permanent histologic sections.
• Discussion of Mohs micrographic surgery (MMS) and intraoperative immunohistochemistry (IHC), particularly MART-1 staining.
• Analysis of techniques like "square," "perimeter," and "contoured" excisions using permanent sections.

Main Results:

• Specialized techniques with meticulous margin assessment demonstrate superior cure rates for LM compared to standard excision.
• Mohs micrographic surgery (MMS) shows low recurrence rates (<1%) over 3-5 years.
• Staged excisions with permanent section analysis are presented as a simple and effective alternative to MMS.

Conclusions:

• Surgical methods with thorough margin assessment are essential for effective LM treatment.
• Both Mohs surgery and staged excisions with permanent sections offer high cure rates.
• Intraoperative IHC, like MART-1, aids in simplifying margin assessment for MMS.