How is lentigo maligna melanoma treated?

Updated: Dec 19, 2019
  • Author: Winston W Tan, MD, FACP; Chief Editor: William D James, MD  more...
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Answer

Answer

Melanoma should be managed by a multidisciplinary team that includes a dermatologist, surgeon, and medical oncologist, as well as other allied health professionals.

Lentigo maligna is treated with surgery. The standard and preferred treatment is surgical excision. However, various nonsurgical modalities are available to patients in whom surgical therapy is not feasible, including cryotherapy and immune response therapy with topical imiquimod. [15, 16]

Melanoma in situ (MIS) is a noninvasive lesion. In a retrospective study of 2,121 patients treated for melanoma by Akhtar et al, [17] 192 patients with MIS were identified; those treated with narrow margins of excision are unlikely to recur; therefore, wider excision is not required.

Radiotherapy in the treatment of lentigo maligna was first described by Miescher in 1954. Other investigators have employed similar techniques with varying results. A primary risk of using radiation therapy for lentigo maligna is that it may miss focal lentigo maligna melanoma.

In one study, radiation therapy was an effective and safe treatment for lentigo melanoma. Radiation was given twice a week over three consecutive weeks in total doses of 100 to 160 Gy, Patients were followed for 2 to 5 years. [18]

In the presence of nodal disease, multiple chemotherapy and immunotherapy drugs have been tested. High-dose alpha-interferon remains the standard adjuvant option, especially with stage III cancer, in which it results in a 9-month increase in disease-free survival and a 1-year increase in overall survival.

With metastatic or unresectable disease, National Comprehensive Cancer Network (NCCN) guidelines recommend choosing therapy on the basis of the tumor's BRAF mutation status (wild type versus mutated). An additional consideration is whether the patient is expected to remain clinically stable for more than 12 weeks (in which case the therapeutic intent is long-term survival) or clinical deterioration is expected in 12 weeks or less. [19]

Vaccines have been tested in various studies, but none have led to any significant survival advantage. Granulocyte-macrophage colony-stimulating factor (GM-CSF) has been found to prolong time to progression compared to historical control in both node-positive and metastatic stage of the disease.

Nonsurgical therapies have a recurrence rate of 20-100% at 5 years.


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