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Staged Excision of Lentigo Maligna and Lentigo Maligna Melanoma: A 10-Year Experience

Bosbous, Mark W., M.D.; Dzwierzynski, William W., M.D.; Neuburg, Marcelle, M.D.

Plastic and Reconstructive Surgery: December 2009 - Volume 124 - Issue 6 - p 1947-1955
doi: 10.1097/PRS.0b013e3181bcf002
RECONSTRUCTIVE: HEAD AND NECK: ORIGINAL ARTICLES
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Background: The treatment of lentigo maligna and lentigo maligna melanoma presents a difficult problem for clinicians. Published guidelines recommend a 5-mm excision margin for lentigo maligna and a 1-cm margin for lentigo maligna melanoma, yet these are often inadequate. The authors' purpose is to report their 10-year experience using staged excision for the treatment of lentigo maligna and lentigo maligna melanoma of the head and neck.

Methods: Staged excision was performed on 59 patients over a 10-year period. Data on patient demographics, lesion characteristics, and treatment were collected through an institutional review board–approved chart review.

Results: Using staged excision, 62.7 percent of patients required a 10-mm or greater margin to achieve clearance of tumor. Two or more stages of excision were required in 50.9 percent of patients. Invasive melanoma (lentigo maligna melanoma) was identified in 10.2 percent of patients initially diagnosed with lentigo maligna. There was one (1.7 percent) documented recurrence during a median 2.25-year follow-up period (range, 0 to 10.17 years).

Conclusions: Staged excision is an effective treatment for lentigo maligna and lentigo maligna melanoma. Previously published recommendations of 5-mm margins for wide local excision are inadequate for tumors located on the head and neck.

Milwaukee, Wis.

From the Departments of Plastic Surgery and Dermatology, Medical College of Wisconsin.

Received for publication April 2, 2009; accepted July 1, 2009.

Presented at the 88th Annual Meeting and Aesthetic Symposium of the American Association of Plastic Surgeons, in Rancho Mirage, California, March 23, 2009, and awarded second place for best poster.

Disclosure:The authors have not received any funding or financial support in preparing this publication and have no commercial associations or financial disclosures that conflict with this article.

William W. Dzwierzynski, M.D.; Department of Plastic Surgery; Medical College of Wisconsin; 8700 Watertown Plank Road; Milwaukee, Wis. 53226; billd@mcw.edu

©2009American Society of Plastic Surgeons