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Staged Excision Techniques

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Lentigo Maligna Melanoma

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Abstract

Lentigo maligna (LM) and lentigo maligna melanoma (LMM) are associated with variable asymmetric subclinical extension. Consequently, standard excision methods may be associated with a higher risk of local recurrence. Staged excision techniques using permanent sections with more comprehensive margin evaluation may be preferred for treating LM and LMM particularly in sun damaged skin on the head and neck. Herein we discuss reported variations of staged excision techniques, advantages and disadvantages, and reported local recurrence rates.

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References

  1. Erickson C, Miller SJ. Treatment options in melanoma in situ: topical and radiation therapy, excision and Mohs surgery. Int J Dermatol. 2010;49(5):482–91.

    Article  PubMed  Google Scholar 

  2. McLeod M, Choudhary S, Giannakakis G, Nouri K. Surgical treatments for lentigo maligna: a review. Dermatol Surg. 2011;37(9):1210–28.

    Article  CAS  PubMed  Google Scholar 

  3. Tzellos T, Kyrgidis A, Mocellin S, Chan AW, Pilati P, Apalla Z. Interventions for melanoma in situ, including lentigo maligna. Cochrane Database Syst Rev. 2014;12, CD010308.

    Google Scholar 

  4. Walling HW, Scupham RK, Bean AK, Ceilley RI. Staged excision versus Mohs micrographic surgery for lentigo maligna and lentigo maligna melanoma. J Am Acad Dermatol. 2007;57(4):659–64.

    Article  PubMed  Google Scholar 

  5. Pitman GH, Kopf AW, Bart RS, Casson PR. Treatment of lentigo maligna and lentigo maligna melanoma. J Dermatol Surg Oncol. 1979;5(9):727–37.

    Article  CAS  PubMed  Google Scholar 

  6. Coleman 3rd WP, Davis RS, Reed RJ, Krementz ET. Treatment of lentigo maligna and lentigo maligna melanoma. J Dermatol Surg Oncol. 1980;6(6):476–9.

    Article  PubMed  Google Scholar 

  7. Osborne JE, Hutchinson PE. A follow-up study to investigate the efficacy of initial treatment of lentigo maligna with surgical excision. Br J Plast Surg. 2002;55(8):611–5.

    Article  CAS  PubMed  Google Scholar 

  8. Zalla MJ, Lim KK, Dicaudo DJ, Gagnot MM. Mohs micrographic excision of melanoma using immunostains. Dermatol Surg. 2000;26(8):771–84.

    Article  CAS  PubMed  Google Scholar 

  9. Zitelli JA, Brown C, Hanusa BH. Mohs micrographic surgery for the treatment of primary cutaneous melanoma. J Am Acad Dermatol. 1997;37(2 Pt 1):236–45.

    Article  CAS  PubMed  Google Scholar 

  10. Hazan C, Dusza SW, Delgado R, Busam KJ, Halpern AC, Nehal KS. Staged excision for lentigo maligna and lentigo maligna melanoma: a retrospective analysis of 117 cases. J Am Acad Dermatol. 2008;58(1):142–8.

    Article  PubMed  Google Scholar 

  11. Huilgol SC, Selva D, Chen C, et al. Surgical margins for lentigo maligna and lentigo maligna melanoma: the technique of mapped serial excision. Arch Dermatol. 2004;140(9):1087–92.

    Article  PubMed  Google Scholar 

  12. Bub JL, Berg D, Slee A, Odland PB. Management of lentigo maligna and lentigo maligna melanoma with staged excision: a 5-year follow-up. Arch Dermatol. 2004;140(5):552–8.

    Article  PubMed  Google Scholar 

  13. Bosbous MW, Dzwierzynski WW, Neuburg M. Staged excision of lentigo maligna and lentigo maligna melanoma: a 10-year experience. Plast Reconstr Surg. 2009;124(6):1947–55.

    Article  CAS  PubMed  Google Scholar 

  14. Prieto VG, Argenyi ZB, Barnhill RL, et al. Are en face frozen sections accurate for diagnosing margin status in melanocytic lesions? Am J Clin Pathol. 2003;120(2):203–8.

    Article  PubMed  Google Scholar 

  15. Jejurikar SS, Borschel GH, Johnson TM, Lowe L, Brown DL. Immediate, optimal reconstruction of facial lentigo maligna and melanoma following total peripheral margin control. Plast Reconstr Surg. 2007;120(5):1249–55.

    Article  CAS  PubMed  Google Scholar 

  16. Agarwal-Antal N, Bowen GM, Gerwels JW. Histologic evaluation of lentigo maligna with permanent sections: implications regarding current guidelines. J Am Acad Dermatol. 2002;47(5):743–8.

    Article  PubMed  Google Scholar 

  17. Mahoney MH, Joseph M, Temple CL. The perimeter technique for lentigo maligna: an alternative to Mohs micrographic surgery. J Surg Oncol. 2005;91(2):120–5.

    Article  PubMed  Google Scholar 

  18. Johnson TM, Headington JT, Baker SR, Lowe L. Usefulness of the staged excision for lentigo maligna and lentigo maligna melanoma: the “square” procedure. J Am Acad Dermatol. 1997;37(5 Pt 1):758–64.

    Article  CAS  PubMed  Google Scholar 

  19. Anderson KW, Baker SR, Lowe L, Su L, Johnson TM. Treatment of head and neck melanoma, lentigo maligna subtype: a practical surgical technique. Arch Facial Plast Surg. 2001;3(3):202–6.

    Article  CAS  PubMed  Google Scholar 

  20. Abdelmalek M, Loosemore MP, Hurt MA, Hruza G. Geometric staged excision for the treatment of lentigo maligna and lentigo maligna melanoma: a long-term experience with literature review. Arch Dermatol. 2012;148(5):599–604.

    Article  PubMed  Google Scholar 

  21. Demirci H, Johnson TM, Frueh BR, Musch DC, Fullen DR, Nelson CC. Management of periocular cutaneous melanoma with a staged excision technique and permanent sections the square procedure. Ophthalmology. 2008;115(12):2295–300. e2293.

    Article  PubMed  Google Scholar 

  22. Malhotra R, Chen C, Huilgol SC, Hill DC, Selva D. Mapped serial excision for periocular lentigo maligna and lentigo maligna melanoma. Ophthalmology. 2003;110(10):2011–8.

    Article  PubMed  Google Scholar 

  23. Hill DC, Gramp AA. Surgical treatment of lentigo maligna and lentigo maligna melanoma. Australas J Dermatol. 1999;40(1):25–30.

    Article  CAS  PubMed  Google Scholar 

  24. Gaudy-Marqueste C, Perchenet AS, Tasei AM, et al. The “spaghetti technique”: an alternative to Mohs surgery or staged surgery for problematic lentiginous melanoma (lentigo maligna and acral lentiginous melanoma). J Am Acad Dermatol. 2011;64(1):113–8.

    Article  PubMed  Google Scholar 

  25. Cohen LM, McCall MW, Zax RH. Mohs micrographic surgery for lentigo maligna and lentigo maligna melanoma. A follow-up study. Dermatol Surg. 1998;24(6):673–7.

    Article  CAS  PubMed  Google Scholar 

  26. Kasprzak JM, Xu YG. Diagnosis and management of lentigo maligna: a review. Drugs Context. 2015;4:212281.

    Article  PubMed  PubMed Central  Google Scholar 

  27. McGuire LK, Disa JJ, Lee EH, Busam KJ, Nehal KS. Melanoma of the lentigo maligna subtype: diagnostic challenges and current treatment paradigms. Plast Reconstr Surg. 2012;129(2):288e–99.

    Article  CAS  PubMed  Google Scholar 

  28. Moller MG, Pappas-Politis E, Zager JS, et al. Surgical management of melanoma-in-situ using a staged marginal and central excision technique. Ann Surg Oncol. 2009;16(6):1526–36.

    Article  PubMed  Google Scholar 

  29. de Vries K, Greveling K, Prens LM, et al. Recurrence rate of lentigo maligna after micrographically controlled staged surgical excision. Br J Dermatol. 2016;174(3):588–93.

    Article  PubMed  Google Scholar 

  30. Dhawan SS, Wolf DJ, Rabinovitz HS, Poulos E. Lentigo maligna. The use of rush permanent sections in therapy. Arch Dermatol. 1990;126(7):928–30.

    Article  CAS  PubMed  Google Scholar 

  31. Cohen LM, McCall MW, Hodge SJ, Freedman JD, Callen JP, Zax RH. Successful treatment of lentigo maligna and lentigo maligna melanoma with Mohs' micrographic surgery aided by rush permanent sections. Cancer. 1994;73(12):2964–70.

    Article  CAS  PubMed  Google Scholar 

  32. Clayton BD, Leshin B, Hitchcock MG, Marks M, White WL. Utility of rush paraffin-embedded tangential sections in the management of cutaneous neoplasms. Dermatol Surg. 2000;26(7):671–8.

    Article  CAS  PubMed  Google Scholar 

  33. Lee MR, Ryman WJ. Treatment of lentigo maligna with total circumferential margin control using vertical and horizontal permanent sections: a retrospective study. Australas J Dermatol. 2008;49(4):196–201.

    Article  PubMed  Google Scholar 

  34. Connolly KL, Nijhawan R, Dusza S, Busam K, Nehal K. Time to local recurrence of lentigo maligna: implications for future studies. J Am Acad Dermatol. 2016;74(6):1247–8.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Cutaneous Surgery and Oncology, Department of Dermatology, University of Michigan Health System, 1910 Taubman Center, 1500 E. Medical Center Dr., SPC 5314, Ann Arbor, MI, 48109-5314, USA

    Kira Mayo MD, Timothy M. Johnson MD & Kelly L. Harms MD, PhD

Authors
  1. Kira Mayo MD
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  2. Timothy M. Johnson MD
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  3. Kelly L. Harms MD, PhD
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Corresponding author

Correspondence to Kelly L. Harms MD, PhD .

Editor information

Editors and Affiliations

  1. Attending Physician, Director of Mohs and Dermatologic Surgery Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, USA

    Kishwer S. Nehal

  2. Attending Pathologist Director of Dermatopathology Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, USA

    Klaus J. Busam

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© 2017 Springer International Publishing Switzerland

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Mayo, K., Johnson, T.M., Harms, K.L. (2017). Staged Excision Techniques. In: Nehal, K., Busam, K. (eds) Lentigo Maligna Melanoma. Springer, Cham. https://doi.org/10.1007/978-3-319-43787-3_6

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  • DOI: https://doi.org/10.1007/978-3-319-43787-3_6

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-43785-9

  • Online ISBN: 978-3-319-43787-3

  • eBook Packages: MedicineMedicine (R0)

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