Lentigo Maligna: Contemporary Surgical Management and Outcome: A Review

Area of Science:

• Dermatology and Oncology
• Surgical Pathology

Background:

• Lentigo maligna (LM) is a common melanoma in situ variant on sun-damaged skin.
• Subclinical spread and atypia complicate surgical clearance and histological interpretation of LM.

Purpose of the Study:

• To appraise contemporary surgical options for LM: wide local excision (WLE), Mohs micrographic surgery (MMS), slow Mohs, and staged excision (SE).
• To compare oncological outcomes of these surgical techniques for LM.

Main Methods:

• Comprehensive literature search (PubMed, Web of Science, Jan 2015-Jan 2025) for studies on LM/LMM surgical techniques and outcomes.
• Qualitative synthesis of 46 retrieved studies including retrospective cohorts, systematic reviews, and meta-analyses.

Main Results:

• WLE showed high heterogeneity, with residual disease rates up to 16.7% and recurrences from 5.7% to 27.3%.
• MMS achieved low recurrence rates (0-3%) with ≥5 years follow-up, especially with immunohistochemistry.
• Slow Mohs and SE offered intermediate control (0-5.7%) but had procedural variability and delayed reconstruction.

Conclusions:

• Margin-controlled techniques (MMS, slow Mohs, SE) provide superior local control over WLE for LM, particularly on critical cosmetic/functional sites.
• Technique selection should balance anatomical location, lesion size, expertise, patient factors, and resources, as survival appears equivalent.
• Prospective trials with standardized protocols are needed to refine margin recommendations and compare long-term outcomes.