Immunocryosurgery as monotherapy for lentigo maligna or combined with surgical excision for lentigo maligna melanoma

The incidence of lentigo maligna (LM), in situ (LM) or invasive (lentigo maligna melanoma, LMM), has increased during the last decades. Due to functional or cosmetic outcomes, optimal treatment with surgical excision may not be appropriate in some cases. We tried less invasive therapy, immunocryosurgery, as a single treatment for LM or combined with surgery for LMM, with better aesthetic results. Three patients with LM or LMM not amenable to complete surgical excision were selected. LMM patients underwent limited surgical resection of the invasive area. Subsequently, a combined treatment with topical imiquimod and cryosurgery was performed. The LM patient received immunocryosurgery directly. All of them were free of local and systemic disease at 48, 42 and 41 months after discontinuation of therapy. We consider that immunocryosurgery is an alternative option for LM or even for LMM (after removal of the invasive tissue with narrow margins) in poor surgical candidates, with good therapeutic, functional and cosmetic results.     

Surgical treatment of lentigo maligna and lentigo maligna melanoma

Lentigo maligna (LM) is well known as an irregularly pigmented macular lesion usually presenting on the sun-damaged head and neck of older patients. Lentigo maligna (LM) has the potential to develop into invasive melanoma (LMM). A method of surgical excision for the treatment of LM and LMM using paraffin sections with tissue mapping to ensure clear margins before delayed defect closure is described. The results of applying this method in the treatment of 66 cases over a 40 month period are presented. Thirty-eight per cent of cases required two excisions or more to clear the tumour and 32% of cases showed evidence of invasive melanoma. Only one case has recurred thus far, and none have developed metastatic disease.     

Cryotherapy for lentigo maligna

Eleven patients, 10 with lentigo maligna (LM) and one with lentigo maligna melanoma (LMM), were treated with cryotherapy. The symptoms cleared in all patients except one with LM. There were recurrences in four patients and three cleared with further treatment.     

The risk of progression of lentigo maligna to lentigo maligna melanoma

An analysis is presented which estimates the risk of progression of lentigo maligna (LM) to lentigo maligna melanoma (LMM) in U.S. whites using three data sources: the Health and Nutrition Examination Survey I for estimation of the age-specific prevalence of LM; the Surveillance, Epidemiology, and End Results Program for estimation of the age-specific incidence of melanoma; and the data from three melanoma registries for estimation of the age-specific case fraction of LMM among all invasive melanomas. The risk varies with age and is likely to be greater than estimated here for patients who present themselves for evaluation of changes in a lesion of LM. Our analysis suggests that the risk of progression from LM to LMM is substantially lower than is commonly believed.     

Contoured technique for lentigo maligna

The surgical approach to lentigo maligna is a challenge to dermatologists, given the difficulty of clinical delimitation of borders. We report here a case of a 69-year-old female patient presenting with brownish macules on her face, since 10 years ago, with histopathological diagnosis of lentigo maligna. The surgical management employed was excision of visible borders with the contoured technique and immediate submission of these borders for histopathological analysis before complete excision of the tumor. This technique is a variant of staged excision, with lower rates of recurrence and acceptable aesthetic results.     

Management of lentigo maligna

Lentigo maligna melanoma is a melanoma in situ on sun-damaged skin. It is a variably brown-pigmented flat patch on the head or neck of elderly patients. Its growth is generally slow, but it can become an invasive form of melanoma. Multiple reported treatment options are reviewed. Wide-margin Mohs micrographic surgery with peripheral permanent pathologic confirmation of a clear margin is recommended as treatment of choice.     

Treatment of lentigo maligna

Lentigo maligna (LM) is an indolent form of melanoma in situ with the potential to progress to invasive melanoma. Early detection and adequate treatment prior to development to invasive melanoma are essential. Definitive excision with negative margins is currently the treatment of choice for LM. Conventional excision, Mohs micrographic surgical excision, and nonexcisional methods of treatment of LM will be discussed.