Importance of Vertical Pathology of Debulking Specimens During Mohs Micrographic Surgery for Lentigo Maligna and Melanoma in Situ

Iorizzo, Luciano J.; Chocron, Isaac; Lumbang, Wilfred A.; Stasko, Thomas

doi:10.1111/dsu.12078

Cited by 42 publications

(31 citation statements)

References 21 publications

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“…Iorizzo et al . found that 8·1% of lentigo maligna and melanoma in situ , diagnosed on biopsy, were invasive melanoma after examination of excision specimen . In our series, five of 100 lesions (5%) diagnosed as lentigo maligna were diagnosed as lentigo maligna melanoma after excision.…”

Section: Discussionmentioning

confidence: 41%

Recurrence rate of lentigo maligna after micrographically controlled staged surgical excision

Vries

Greveling

Prens

et al. 2016

British Journal of Dermatology

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Section: Discussionmentioning

confidence: 41%

Recurrence rate of lentigo maligna after micrographically controlled staged surgical excision

Vries

Greveling

Prens

et al. 2016

British Journal of Dermatology

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“…In the author's experience, skip areas have been occasionally observed but the true incidence is unknown. Overall, the rate of upstaging from LM to invasive disease upon final excision (11.7%) was high but within the expected range compared with other recently reported rates of upstaging for LM and melanoma in situ (4-11.7%) [15,[19][20][21]. Thus, the prior cosmetic treatment did not appear to have an effect on overall prognosis, but the wider surgical margins resulted in larger defects creating reconstructive challenges and increased morbidity.…”

Section: Discussionsupporting

confidence: 51%

Lentigo maligna melanoma with a history of cosmetic treatment: Prevalence, surgical outcomes and considerations

et al. 2017

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Introduction Lentigo maligna (LM) is melanoma in situ on sun-damaged skin and presents diagnostic challenges due to overlapping features with benign pigmented lesions. Cosmetic treatments may be inadvertently performed on LM. The aim of this study is to estimate the prevalence of LM with prior cosmetic treatment, and evaluate surgical outcomes. Study Design and Methods Retrospective review of biopsy-proven LM presenting over a ten-year period (2006–2015). Prior cosmetic treatment and biopsies were recorded. Records were reviewed for demographic data, clinical characteristics, and surgical outcomes. Results 37/503 (7.4%) patients with LM reported prior cosmetic therapy. Most (95%) were on the head and neck; mean size 1.9 centimeters. Most patients reported cryotherapy (73%), followed by laser (29.7%), topical bleaching agents (18.9%), and electrodessication and/or curettage (5.3%). Ten patients (27%) received two or more modalities. Eight patients (21.6%) reported prior benign biopsies. Six patients (16%) had invasive disease, two on initial biopsy and 4/34 (11.7%) upstaged upon excision. Average margin for clearance was 9.1 millimeters. Conclusion Prior cosmetic treatment of LM is not uncommon, and may delay diagnosis and obscure borders, resulting in wider surgical margins. Clinicians should consider a biopsy confirming the benign nature of equivocal lesions prior to cosmetic treatment.

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“…On the other hand, it is also possible that there may be an underestimation of the cumulative risk of LMM after LM, because LM is normally treated in the Netherlands, which would decrease the risk of progression. Also, some of the LM diagnosed as an in situ lesion by initial biopsy or conventional excision may have already had an unrecognized component of dermal invasive melanoma and were actually representing LMM (Abdelmalek et al, 2012;Hazan et al, 2008;Iorizzo et al, 2013). Finally, LMM registered without a previous diagnosis of LM would not have been included in our analysis and may also have resulted in an underestimation.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of Lentigo Maligna and Lentigo Maligna Melanoma in the Netherlands, 1989–2013

Greveling

Wakkee

Nijsten

et al. 2016

Journal of Investigative Dermatology

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Lentigo maligna (LM) is considered a precursor to LM melanoma (LMM). We assessed trends in LM and LMM incidence rates between 1989 and 2013 in the Netherlands, and estimated the risk of an LMM after LM. Data on newly diagnosed LM and LMM were obtained from the Netherlands Cancer Registry and PALGA: Dutch Pathology Registry. Age-standardized incidence rates (European standardized rate), estimated annual percentage changes, and the cumulative incidence of LMM after LM were calculated. Between 1989 and 2013, 10,545 patients were diagnosed with a primary LM and 2,898 with a primary LMM in the Netherlands. The age-standardized incidence rate for LM increased from 0.72 to 3.84 per 100,000 person-years, and for LMM from 0.24 to 1.19 between 1989 and 2013. LM incidence increased from 2002 to 2013 with 6.8% annually, before an even steeper rise in LMM incidence from 2007 to 2013 (estimated annual percentage change: 12.4%). The cumulative incidence of LMM after a primary LM after 25-year follow-up was 2.0% for males and 2.6% for females. The increased incidence of LM and LMM in the Netherlands seems, besides increased awareness and increased histological confirmation of LM, to reflect a true increase. The absolute risk of an LMM (at any location) after a histologically confirmed LM was low (2.0-2.6%).

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Importance of Vertical Pathology of Debulking Specimens During Mohs Micrographic Surgery for Lentigo Maligna and Melanoma in Situ

Abstract: When performing MMS for LM or MIS, it is appropriate and necessary to send the central debulking specimen for permanent histology for accurate tumor staging.

Cited by 42 publications

References 21 publications

Recurrence rate of lentigo maligna after micrographically controlled staged surgical excision

Recurrence rate of lentigo maligna after micrographically controlled staged surgical excision

Lentigo maligna melanoma with a history of cosmetic treatment: Prevalence, surgical outcomes and considerations

Epidemiology of Lentigo Maligna and Lentigo Maligna Melanoma in the Netherlands, 1989–2013

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