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Margin control for lentigo maligna

J K Robinson1

  • 1Department of Dermatology, Northwestern University Medical School, Chicago, IL 60611.

Journal of the American Academy of Dermatology
|July 1, 1994
PubMed
Summary
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Surgical excision is the primary treatment for lentigo maligna. This study found that using HMB-45 antibody can help achieve narrower resection margins, potentially reducing scarring.

Area of Science:

  • Dermatology
  • Surgical Oncology
  • Pathology

Background:

  • Lentigo maligna, a form of in situ melanoma, is typically treated with surgical excision.
  • Current recommendations advise local resection with 0.5-1.0 cm margins, but narrower margins are desired, especially on the face, to minimize scarring.
  • Mohs micrographic surgery is debated for its efficacy in preserving normal tissue while resecting lentigo maligna.

Purpose of the Study:

  • To determine the narrowest effective resection margin for lentigo maligna.
  • To assess the accuracy of frozen and fixed histologic specimens for margin evaluation.
  • To retrospectively evaluate the utility of S-100 protein and HMB-45 monoclonal antibodies in identifying atypical melanocytes.

Main Methods:

  • 16 cases of lentigo maligna underwent serial excisions at varying distances (0.3, 0.6, 1.0, 1.3 cm) from the clinical margin, delineated by Wood's light.

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  • Frozen sections were compared with fixed histopathologic specimens.
  • Tissue blocks were retrospectively stained with S-100 protein and HMB-45 antibodies.
  • Patients were followed for 5-9 years for recurrence.

    • Main Results:

    • One recurrence was observed 8 years post-surgery.
    • Resection margins generally ranged from 0.6-1.0 cm, with smaller lesions (<2.0 cm) requiring narrower margins and larger lesions (>3.0 cm) requiring wider margins (>1.0 cm).
    • S-100 protein antibody lacked sensitivity and specificity; HMB-45 antibody demonstrated sensitivity and aided in identifying atypical melanocytes.

    Conclusions:

    • Modified Mohs micrographic surgery techniques, incorporating fixed histopathologic specimens and HMB-45 antibody staining, may enable narrower resection margins for lentigo maligna.
    • This approach holds promise for improving cosmetic outcomes by reducing scarring.
    • HMB-45 antibody is a valuable adjunct for delineating atypical melanocytes in lentigo maligna resection.