What are the treatment guidelines 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

Answer

Guidelines on the management of lentigo maligna from Cancer Council Australia and Melanoma Institute Australia include the following recommendations [1]

  • The diagnosis of lentigo maligna is made using the results from biopsy and histopathology studies. Because the risk of lentigo maligna progressing to invasive melanoma generally is low and can take many years, watchful waiting (monitoring the lesions over time) may be a more appropriate approach in very elderly patients or those with significant comorbidities. A biopsy of suggestive areas can be performed if significant dermatoscopic or clinical changes are noted.
  • Mohs micrographic surgery has been shown to be superior to conventional surgical removal, yielding improved complete clearance rates and reduced recurrence. When possible, complete surgical removal with clinical margins of 5-10 mm is recommended. Consideration should be given to using perioperative reflectance confocal microscopy for assessing clinical margins, if it is available.
  • An acceptable recommended alternative to surgical removal or as adjunctive treatment after surgical removal is ultrasoft x-ray/grenz ray therapy, particularly for large lesions.
  • If surgical excision and ultrasoft x-ray/grenz ray therapy are contraindicated or refused by the patient, imiquimod therapy is recommended. Note that radiotherapy has been shown to be superior to imiquimod in terms of complete clearance and recurrence. Tazarotene can be added to imiquimod therapy to increase the inflammatory response; however, whether this improves treatment efficacy has not been determined.
  • Neither cryotherapy nor laser therapy is recommended for treating lentigo maligna.

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