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Type: Journal article
Title: Surgical margins for lentigo maligna and lentigo maligna melanoma - The technique of mapped serial excision
Author: Huilgol, S.
Selva-Nayagam, D.
Chen, C.
Hill, D.
James, C.
Gramp, A.
Malhotra, R.
Citation: Archives of Dermatology, 2004; 140(9):1087-1092
Publisher: Amer Medical Assoc
Issue Date: 2004
ISSN: 0003-987X
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.
Keywords: Humans
Hutchinson's Melanotic Freckle
Skin Neoplasms
Neoplasm Recurrence, Local
Neoplasm Staging
Treatment Outcome
Mohs Surgery
Confidence Intervals
Risk Assessment
Sensitivity and Specificity
Statistics, Nonparametric
Cohort Studies
Follow-Up Studies
Prospective Studies
Aged, 80 and over
Middle Aged
DOI: 10.1001/archderm.140.9.1087
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Appears in Collections:Aurora harvest 2
Surgery publications

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