How effective is surgery for lentigo maligna melanoma?

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

Standard excisions have a recurrence rate of 8-20%. Mohs surgery and staged excision may offer better control and lower recurrence rates (up to 5%). [22, 23, 24, 25] A study of Mohs surgery using immunostaining of frozen sections with melanoma antigen recognized by T cells 1 (MART-1) reported a recurrence rate of less than 1%. [26]

Surgical excision with 5-mm margin is often inadequate for lentigo maligna on sun-damaged skin where a background of melanocytic hyperplasia obscures the true borders of the lesion. The cure rate is 80-94%, but staged margin excisions using frozen, or permanent, sections consistently provided much higher cure rates. [27]

A review of staged excision as treatment of lentigo maligna concluded that this technique provides a long disease-free survival of 95% with follow-up of 57 months. [24] The technique included vertical excision with initial 2- to 3-mm margins and examination of permanent sections within 24 hours. Further excisions took place as guided by the histologic findings. [24]

Hazan et al studied staged excision of lentigo maligna and lentigo maligna melanoma in the head and neck region of 117 cases and reported that the mean total surgical margin for excision of lentigo maligna was 7.1 mm and 10.3 mm for lentigo maligna melanoma. [28]


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