Surgical margins for lentigo maligna and lentigo maligna melanoma - The technique of mapped serial excision

Abstract

<h4>Objectives</h4>To assess the margins required for excision of lentigo maligna (LM) and lentigo maligna melanoma (LMM) by the technique of mapped serial excision (MSE), and to assess the efficacy of MSE.<h4>Design</h4>An interventional, prospective, noncontrolled case series.<h4>Setting</h4>Tertiary referral, dermatologic surgery unit.<h4>Patients</h4>Consecutive patients with head and neck LM or LMM who underwent MSE between March 1, 1993, and October 31, 2002.<h4>Intervention</h4>The MSE of LM or LMM.<h4>Main outcome measures</h4>The number of 5-mm levels for excision of LM and LMM and recurrence.<h4>Results</h4>One hundred sixty-one LMs or LMMs in 155 patients were treated. Thirty percent (37 of 125) of LMs required more than 5-mm margins. For LMMs less than 1 mm in Breslow thickness, 12% (4/32) required more than 10-mm margins. For primary tumors, 20% of LMs (18 of 91) required more than 5-mm margins, while 10% of LMMs less than 1 mm in Breslow thickness (2 of 21) required more than a 10-mm margin. For recurrent tumors, 56% of LMs (19/34) required more than a 5-mm margin. Mean follow-up of 38 months (range, 5-100 months) showed 4 recurrences (2%) after MSE. The extrapolated recurrence at 5 years was 5.0%.<h4>Conclusions</h4>The current recommendations of 5-mm margins for LM and 10-mm margins for LMM less than 1 mm in Breslow thickness are often insufficient. Our results demonstrate the importance of margin-controlled excision, particularly in recurrent lesions. The use of MSE offers a high cure rate, in conjunction with tissue conservation.