Lentigo maligna is a subtype of in situ melanoma appearing usually in chronically sun-exposed skin (mostly the face) of elderly patients. It manifests clinically as a flat macule with irregular contours and heterogeneous pigmentation. It grows slowly over years but may eventually progress into a vertical growth phase and transform into an invasive melanoma (lentigo maligna melanoma) that has potential for metastasis and lethal outcome; accordingly, this lesion is nowadays regarded more as an authentic in situ melanoma rather than a premalignant condition. There are no prospective, randomised controlled studies evaluating the efficacy of the various treatment modalities applied for the treatment of lentigo maligna. Surgical excision with tumour-free margins is regarded as the best treatment modality, providing the best chances of clearance. Excision can be performed as traditional, one-step tumour ablation with 5–10 mm safety margins or (preferably) with margin-controlled techniques, such as staged excision or Mohs micrographic surgery, the latter two being associated with the lowest recurrence rates. In case of surgically unresectable tumours or in frail patients with severe comorbidities, alternative nonsurgical therapies can be applied, including imiquimod, radiotherapy and cryotherapy/cryosurgery.
KeywordsLentigo maligna Lentigo maligna melanoma Hutchinson’s melanotic freckle Melanosis circumscripta precancerosa of Dubreuilh Standard local excision Mohs micrographic surgery Staged surgical excision Radiotherapy Imiquimod Cryotherapy
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