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The smart approach: feasibility of lentigo maligna superficial margin assessment with hand-held reflectance confocal

G Pellacani1, N De Carvalho1, S Ciardo1

  • 1Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.

Journal of the European Academy of Dermatology and Venereology : JEADV
|April 29, 2018
PubMed
Abstract

Insights

Superficial skin cuts used with reflectance confocal microscopy (RCM) can help achieve negative surgical margins for lentigo maligna. This imaging technique shows feasibility for precise melanoma excision, reducing recurrence risk.

Area of Science:

  • Dermatology
  • Oncology
  • Medical Imaging

Background:

  • Lentigo maligna presents surgical challenges for complete tumor removal.
  • Achieving clear surgical margins is crucial for preventing melanoma recurrence.

Purpose of the Study:

  • To assess the feasibility of using superficial skin cuts as anchors for reflectance confocal microscopy (RCM) imaging.
  • To determine if RCM imaging can guide surgical excision to attain negative margins for lentigo maligna.

Main Methods:

  • Patients with lentigo maligna near sensitive facial areas were evaluated using a hand-held RCM.
  • Microscopic margin clearance was assessed beyond dermoscopic edges, with margins annotated by shallow skin cuts.
  • Positive margins identified by RCM were sequentially expanded until RCM-negative margins were confirmed histopathologically.

Main Results:

  • The study included 126 margin evaluations in 23 patients; 74% had in-situ melanoma.
  • RCM identified negative margins in 26% of cases on the first assessment, with further clearance in subsequent steps.
  • Histopathology confirmed RCM-negative margins were clear of melanoma in all evaluated cases, with no recurrence at 1-year follow-up.

Conclusions:

  • Hand-held RCM with superficial skin cuts is a feasible method for margin mapping in lentigo maligna.
  • This RCM-guided approach shows promise for improving surgical outcomes in lentigo maligna treatment.
  • Larger studies are needed to validate these findings and establish widespread clinical utility.

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