A two-stage treatment of lentigo maligna using ablative laser therapy followed by imiquimod: excellent cosmesis, but frequent recurrences on the nose

Greveling, Karin; Vries, K. de; Doorn, Martijn van; Prens, Errol P.

doi:10.1111/bjd.14330

Cited by 12 publications

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“…This results in a considerably higher load of atypical melanocytes in deeper parts of the appendages, and may explain why LM recurrences occurred almost exclusively on the nose after our non-surgical treatment method. 5 The maximum absolute depth of the PSU itself was found to be greater on the nose than the cheek, while we did not find a statistically significant difference in the ratio of extension of atypical melanocytes down the PSU between the nose and the cheek. This suggests that the melanocytes extended deeper on the nose than the cheek, simply because the PSU are deeper on the nose, and that there seems to be no intrinsic difference in behaviour of atypical melanocytes between these two sites.…”

Section: Discussioncontrasting

confidence: 72%

“…In a previous publication, we introduced a non‐surgical combination treatment of ablative laser therapy followed by topical application of imiquimod 5% cream . Recently, we found six local recurrences in our cohort of 35 patients . Five of the six recurrences occurred on the nose (out of a total of 15 treated LM on the nose).…”

Section: Introductionmentioning

confidence: 76%

“…Our study shows that both the density of the PSU, and the maximum downward extension of atypical melanocytes along the PSU are higher on the nose than on the cheek. This results in a considerably higher load of atypical melanocytes in deeper parts of the appendages, and may explain why LM recurrences occurred almost exclusively on the nose after our non‐surgical treatment method …”

Section: Discussionmentioning

confidence: 92%

“…4 Recently, we found six local recurrences in our cohort of 35 patients. 5 Five of the six recurrences occurred on the nose (out of a total of 15 treated LM on the nose).…”

Section: Introductionmentioning

confidence: 94%

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Lentigo maligna – anatomic location as a potential risk factor for recurrences after non‐surgical treatment

Greveling

Klok

Doorn

et al. 2016

Acad Dermatol Venereol

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BackgroundA higher incidence of lentigo maligna (LM) recurrences on the nose was previously observed in our cohort after non‐surgical treatment.ObjectivesTo determine histological parameters that might be related to the previously observed higher incidence of LM recurrences on the nose after non‐surgical treatment.MethodsWe randomly selected 22 surgical specimens of LM on the nose and 22 on the cheek. Histopathological analysis was performed on haematoxylin and eosin stained and microphthalmia transcription factor immunohistochemically stained slides. The number of pilosebaceous units (PSU) per mm, maximum depth of atypical melanocytes along the skin appendages and maximum depth of the PSU itself were determined.ResultsThe nose had a significantly higher density of PSU than the cheek. The atypical melanocytes extended deeper along the PSU on the nose with a mean (SD) depth of 1.29 mm (0.48) vs. a mean depth of 0.72 mm (0.30) on the cheek (P < 0.001). The maximum depth of the PSU on the nose was greater than on the cheek, mean (SD) depth of 2.28 mm (0.41) vs. 1.65 mm (0.82) (P = 0.003).ConclusionsThe higher recurrence risk of LM on the nose after non‐surgical treatment that we previously observed in our cohort is most likely based on a higher density of atypical melanocytes and also their deeper extension into the follicles. These results shed more light on our previous findings and learn that anatomical location is relevant for the risk of recurrence of LM after non‐surgical treatment.

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Section: Discussioncontrasting

confidence: 72%

Section: Introductionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 92%

“…4 Recently, we found six local recurrences in our cohort of 35 patients. 5 Five of the six recurrences occurred on the nose (out of a total of 15 treated LM on the nose).…”

Section: Introductionmentioning

confidence: 94%

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Lentigo maligna – anatomic location as a potential risk factor for recurrences after non‐surgical treatment

Greveling

Klok

Doorn

et al. 2016

Acad Dermatol Venereol

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“…Signifi cant pigmentation was observed in the treated area during ongoing follow-ups in three patients (24,30 and 36 months after laser treatment). One patient had a strongly suspected small recurrence of in situ melanoma (5 mm in diameter); she declined biopsy and further treatment of her skin disease (internal cancer with poor prognosis).…”

Section: Resultsmentioning

confidence: 96%

The use of 2940‐nm ER:YAG laser for the treatment of lentigo maligna

Fikrle

Divišová

Šuchmannová

et al. 2019

J Deutsche Derma Gesell

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ZusammenfassungZiele: Die Lentigo maligna ist ein bei älteren Patienten häufig auftretendes malignes Carcinoma in situ mit einem geringen invasiven Progressionsrisiko. Da ein chirurgisches Vorgehen schwierig sein kann oder vom Patienten abgelehnt wird, besteht ein Bedarf an nichtoperativen Therapieoptionen wie beispielsweise eine Laserbehandlung. Patienten und Methoden: Wir berichten über 17 Patienten, die wegen einer histopathologisch gesicherten Lentigo maligna mit einem 2940 nm Er:YAG-Laser (Erbium-dotierter Yttrium-Aluminium-Granat-Laser) behandelt wurden. Die Ablation der Läsionen schloss einen Sicherheitsabstand von 5 mm ein und wurde unter Lokalanästhesie mit überlappenden Laserspots (3,5 mm), einer Energiedichte von 6,5 J/cm 2 und einer Wiederholungsrate von 5 Hz durchgeführt. Trat im abladierten Bereich während der nachfolgenden drei Monate eine klinisch erkennbare Pigmentierung auf, wurde die Läsion erneut behandelt. Bei allen Patienten erfolgte eine Nachkontrolle auf residuale oder rezidivierende Tumoren. Ergebnisse: Wir konnten bei allen 17 Patienten klinische Tumorfreiheit erreichen. Während der Nachsorge traten drei Rezidive auf (9, 30 und 36 Monate nach der Laserbehandlung). Alle Patienten waren mit dem Behandlungsverlauf und dem kosmetischen Ergebnis zufrieden. Die mittlere Dauer der Nachkontrolle betrug 28 Monate. Schlussfolgerungen: Die Laserablation ist eine interessante alternative Therapieoption bei Lentigo maligna. Sie kann in ausgewählten Fällen eingesetzt werden, bei denen ein chirurgisches Vorgehen kontraindiziert oder schwierig ist oder vom Patienten abgelehnt wird. SummaryObjectives: Lentigo maligna is a common in situ malignancy in elderly patients, with a low risk of progression to an invasive tumor. Surgical treatment may be complicated or refused. Non-surgical treatment options (such as lasers) may therefore be needed. Patients and Methods: We report on 17 patients treated with a 2940-nm Er:YAG (erbium-doped yttrium aluminum) laser for histopathologically confirmed lentigo maligna. The lesions were ablated with a 5 mm margin of adjacent skin under local anesthesia with a 3.5 mm overlapping spot, energy density of 6.5 J/cm 2 and a repetition rate of 5 Hz. If clinically visible pigmentation was seen in the ablated area during the following three months, the lesion was re-treated. All patients were followed up for residual or recurrent tumors. Results: We achieved clinical clearance in all 17 patients. There were three recurrences during the follow-up period (9, 30 and 36 months after laser therapy). All patients were satisfied with the treatment course and cosmetic outcome. The mean follow-up duration was 28 months.

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Lentigo Maligna

Kanitakis

2023

European Handbook of Dermatological Treatments

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A two-stage treatment of lentigo maligna using ablative laser therapy followed by imiquimod: excellent cosmesis, but frequent recurrences on the nose

Abstract: A two-stage treatment of lentigo maligna using ablative laser therapy followed by imiquimod: excellent cosmesis, but frequent recurrences on the nose

Cited by 12 publications

References 12 publications

Lentigo maligna – anatomic location as a potential risk factor for recurrences after non‐surgical treatment

Lentigo maligna – anatomic location as a potential risk factor for recurrences after non‐surgical treatment

The use of 2940‐nm ER:YAG laser for the treatment of lentigo maligna

Lentigo Maligna

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