Skip to main content
SpringerLink
Log in

Management of Eyelid Lentigo Maligna

  • Chapter
  • First Online:
Lentigo Maligna Melanoma

  • 679 Accesses

Abstract

Eyelid melanoma accounts for 1 % of cutaneous melanoma and malignant lesions of the eyelid. Lentigo maligna (LM) and lentigo maligna melanoma (LMM) have been reported in higher frequency in the periocular area compared to other parts on the body. LM is a slowly progressive irregular pigmentation of the skin confined to the epidermis, found in areas of solar damaged skin, and more commonly in fair skinned, older individuals. Delay in diagnosis is not uncommon because these changes can be subtle and biopsy in this anatomically sensitive area is often perceived to be complex. LM/LMM of the eyelid and periocular area show no significant difference in their behavior and prognosis compared to similar lesions in the head and neck area. In this chapter we will discuss the management and special considerations associated with the treatment of lentigo maligna in the periocular area.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Rodriguez-Sains RS, Jakobiec FA. Eyelid and conjunctival neoplasms. In: Nesi F, Lisman R, Levine M, editors. Smith’s ophthalmic plastic and reconstructive surgery. St. Louis: CV Mosby; 1998. p. 559–75.

    Google Scholar 

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

    Article  PubMed  Google Scholar 

  3. Weinstock MA, Sober AJ. The risk of progression of lentigo maligna to lentigo maligna melanoma. Br J Dermatol. 1987;116:303.

    Article  CAS  PubMed  Google Scholar 

  4. Esmaeli B, Wang B, Deavers M, Gillenwater A, Goepfert H, Diaz E, Eicher S. Prognostic factors for survival in malignant melanoma of the eyelid skin. Ophthal Plast Reconstr Surg. 2000;16:250–7.

    Article  CAS  PubMed  Google Scholar 

  5. Chopra K, Calva D, Sosin M, Tadisina KK, Banda A, De La Cruz C, Chaudhry MR, Legesse T, Drachenberg CB, Manson PN, Christy MR. A comprehensive examination of topographic thickness of skin in the human face. Aesthet Surg J. 2015;35:1007–13.

    Article  PubMed  Google Scholar 

  6. Hicks C, Liu C, Hiranandani M, Garner A, Hugerford J. Conjunctival melanoma after excision of a lentigo maligna melanoma in the ipsilateral eyelid skin. Br J Ophthalmol. 1994;78:317–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Cook Jr BE, Bartley GB. Treatment options and future prospects for the management of eyelid malignancies: an evidence-based update. Ophthalmology. 2001;108:2088–98.

    Article  PubMed  Google Scholar 

  8. Hudson DA, Krige JEJ, Grobbelaar AO, et al. Melanoma of the face: the safety of narrow excision margins. Scand J Plast Reconstr Surg Hand Surg. 1998;32:97–104.

    Article  CAS  PubMed  Google Scholar 

  9. Veronesi U, Cascinelli N, Adamus J, et al. Thin stage 1 primary cutaneous malignant melanoma: comparison of excision with margins of 1 or 3 cm. N Engl J Med. 1988;318:1159–62.

    Article  CAS  PubMed  Google Scholar 

  10. Esmaeli B, Youssef A, Naderi A, et al. Margins of excision for cutaneous melanoma of the eyelid skin: the Collaborative Eyelid Skin Melanoma Group report. Ophthal Plast Reconstr Surg. 2003;19:96–101.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  12. Binder M, Schwarz M, Winkler A, Steiner A, Kaider A, Wolff K, Pehamberger H. Epiluminescence microscopy. A useful tool for the diagnosis of pigmented skin lesions for formally trained dermatologists. Arch Dermatol. 1995;13:286–91.

    Article  Google Scholar 

  13. Guitera P, Moloney FJ, Menzies SW, Stretch JR, Quinn MJ, Hong A, Fogarty G, Scolyer RA. Improving management and patient care in lentigo maligna by mapping with in vivo confocal microscopy. JAMA Dermatol. 2013;149:692–8.

    Article  PubMed  Google Scholar 

  14. Menge TD, Hibler BP, Cordova MA, Nehal KS, Rossi AM. Concordance of handheld reflectance confocal microscopy (RCM) with histopathology in the diagnosis of lentigo maligna (LM): a prospective study. J Am Acad Dermatol. 2016;26 [Epub ahead of print].

    Google Scholar 

  15. Then SY, Malhotra R, Barlow R, Kurwa H, Huilgol S, Joshi N, Olver J, Collin R, Selva D. Early cure rates with narrow-margin slow-Mohs surgery for periocular malignant melanoma. Dermatol Surg. 2009;35:17–23.

    CAS  PubMed  Google Scholar 

  16. 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;115:2295–300.

    Article  PubMed  Google Scholar 

  17. Glat PM, Longaker MT, Jelks EB, et al. Periorbital melanocytic lesions: excision and reconstruction in 40 patients. Plast Reconstr Surg. 1998;102:19–27.

    Article  CAS  PubMed  Google Scholar 

  18. Grichnik JM, Swetter SM, Tsao H, Barbosa VH, Chuang TY, Duvic M, Ho VC, Sober AJ, Beutner KR, Bhushan R, Smith Begolka W, American Academy of Dermatology. Guidelines of care for the management of primary cutaneous melanoma. J Am Acad Dermatol. 2011;65:1032–47.

    Article  PubMed  Google Scholar 

  19. Kai AC, Richards T, Coleman A, Mallipeddi R, Barlow R, Craythorne EE. Five-year recurrence rate of lentigo maligna after treatment with imiquimod. Br J Dermatol. 2016;174:165–8.

    Article  CAS  PubMed  Google Scholar 

  20. Demirci H, Shields CL, Bianciotto CG, Shields JA. Topical imiquimod for periocular lentigo maligna. Ophthalmology. 2010;117:2424–9.

    Article  PubMed  Google Scholar 

  21. Elia MD, Lally SE, Hanlon AM, Choi JN, Servat JJ, Shields JA, Shields CL, Levin F. Periocular melanoma in situ treated with imiquimod. Ophthal Plast Reconstr Surg. 2015 [Epub ahead of print]

    Google Scholar 

  22. Bratton EM, Knutsen-Larson S, Durairaj VD, Gregory DG, Mellette JR. Combination topical therapy for conjunctival primary acquired melanosis with atypia and periocular lentigo maligna. Cornea. 2015;34:90–3.

    Article  PubMed  Google Scholar 

  23. Swetter SM, Chen FW, Kim DD, Egbert BM. Imiquimod 5 % cream as primary or adjuvant therapy for melanoma in situ, lentigo maligna type. J Am Acad Dermatol. 2015;72:1047–53.

    Article  CAS  PubMed  Google Scholar 

  24. Mora AN, Karia PS, Nguyen BM. A quantitative systematic review of the efficacy of imiquimod monotherapy for lentigo maligna and an analysis of factors that affect tumor clearance. J Am Acad Dermatol. 2015;73:205–12.

    Article  CAS  PubMed  Google Scholar 

  25. Alarcon I, Carrera C, Alos L, Palou J, Malvehy J, Puig S. In vivo reflectance confocal microscopy to monitor the response of lentigo maligna to imiquimod. J Am Acad Dermatol. 2014;71:49–55.

    Article  CAS  PubMed  Google Scholar 

  26. Collins P, Rogers S, Goggin M, Manning W. Cryotherapy for lentigo maligna. Clin Exp Dermatol. 1991;16:433–5.

    Article  CAS  PubMed  Google Scholar 

  27. Bohler-Sommeregger K, Schuller-Petrovic S, Neumann R, Muller E. Cryosurgery of lentigo maligna. Plast Reconstr Surg. 1992;90:436–44.

    Article  CAS  PubMed  Google Scholar 

  28. Farshad A, Burg G, Panizzon R, Dummer R. A retrospective study of 150 patients with lentigo maligna and lentigo maligna melanoma and the efficacy of radiotherapy using Grenz or soft X-rays. Br J Dermatol. 2002;146:1042–6.

    Article  CAS  PubMed  Google Scholar 

  29. Fogarty GB, Hong A, Scolyer RA, Lin E, Haydu L, Guitera P, Thompson J. Radiotherapy for lentigo maligna: a literature review and recommendations for treatment. Br J Dermatol. 2014;170:52–7.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA

    Brian P. Marr MD

Authors
  1. Brian P. Marr MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Brian P. Marr MD .

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

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Marr, B.P. (2017). Management of Eyelid Lentigo Maligna. In: Nehal, K., Busam, K. (eds) Lentigo Maligna Melanoma. Springer, Cham. https://doi.org/10.1007/978-3-319-43787-3_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-43787-3_9

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-43785-9

  • Online ISBN: 978-3-319-43787-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation