Prospective study of formalin-fixed Mohs surgery and haematoxylin and eosin stains with control contralateral biopsies for lentigo maligna: 5-year follow-up results

Lawrence, C.M.; Rahim, Rajib R.; Charlton, Fraser; Husain, Akhtar

doi:10.1111/bjd.12841

Cited by 27 publications

(26 citation statements)

References 38 publications

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“…Also, many features of LM can be seen in chronically actinically damaged skin, including confluent melanocytes and adnexal extension, which can be highlighted by immunostains [47]. For these reasons and others, accuracy of diagnosis of LM and LMM on frozen en face sections has been questioned [48,49]. Despite these potential pitfalls, the majority of recurrence rates have been reported in the range of <1-6.3%, with an isolated smaller study showing 33% recurrence [40,42,50].…”

Section: Treatmentmentioning

confidence: 99%

Lentigo Maligna and Lentigo Maligna Melanoma: Contemporary Issues in Diagnosis and Management

2015

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Lentigo maligna and lentigo maligna melanomas present diagnostic and treatment dilemmas due to their frequent presence within a background of sun-damaged skin, and their location on cosmetically and functionally sensitive areas. As the incidence of this entity is increasing, diagnostic and management controversies have developed. While surgery remains the gold standard of treatment, nonsurgical treatment options are also emerging for both adjunctive and primary therapy.

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Section: Treatmentmentioning

confidence: 99%

Lentigo Maligna and Lentigo Maligna Melanoma: Contemporary Issues in Diagnosis and Management

2015

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“…Early detection and adequate treatment with negative margins is important prior to progression to invasive melanoma. It has been well-established in the dermatology literature that standard 5 mm margins are inadequate for complete margin control in large series of LM [11,[15][16][17][18]. In a previously published series from our institution utilizing the same staged surgical technique, the margins required for clearance of LM was 7.1 mm, and for LMM was 10.3 mm [9].…”

Section: Discussionmentioning

confidence: 93%

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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“…Lawrence et al . showed that the use of slow‐Mohs formalin‐fixed tissue and H&E section staining, even with site‐matched contralateral biopsies, does not provide sufficient discrimination to identify residual disease confidently . However, they did not perform immunohistochemistry …”

Section: Reportmentioning

confidence: 99%

“…9 Lawrence et al 10 showed that the use of slow-Mohs formalin-fixed tissue and H&E section staining, even with site-matched contralateral biopsies, does not provide sufficient discrimination to identify residual disease confidently. 10 However, they did not perform immunohistochemistry. 10 Our data on LM/LMM is in line with the results reported by Paul and Gernand, 9 showing that the frequency of peritumoural melanocytes is increased compared with healthy skin.…”

Section: Reportmentioning

confidence: 99%

“…10 However, they did not perform immunohistochemistry. 10 Our data on LM/LMM is in line with the results reported by Paul and Gernand, 9 showing that the frequency of peritumoural melanocytes is increased compared with healthy skin. We found in the current study that R21 immunostaining was increased in perilesional LM/LMM skin compared with contralateral skin.…”

Section: Reportmentioning

confidence: 99%

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Melanocytic soluble adenylyl cyclase protein expression around lentigo maligna and in contralateral control skin

et al. 2018

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Summary Recurrence rates of both lentigo maligna (LM) and lentigo maligna melanoma (LMM) following conventional surgery are usually relatively high. We aimed to assess the frequencies of melanocytes in tumour‐free margins around LM/LMM using soluble adenylyl cyclase (sAC) immunohistochemistry, and to compare these with those of matched healthy contralateral skin. Using the primary mouse‐anti‐human sAC antibody R21, we evaluated pan‐nuclear melanocytic R21 immunostaining, and found that it was significantly (P < 0.001) higher in peritumoural melanocytes (median 20%; range 0–100%) than in contralateral healthy skin (mean 0%; range 0–20%). Accordingly, there was no correlation between peritumoural and contralateral R21 immunoreactivity (r = 0.12; P = 0.18). In conclusion, melanocytic R21 immunoreactivity in melanocytes is higher in tumour‐free margins around LM/LMM than in site‐matched contralateral skin. This observation may indicate that the biology of ‘healthy’‐appearing melanocytes around LM/LMM might be different from that of truly benign melanocytes.

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Prospective study of formalin-fixed Mohs surgery and haematoxylin and eosin stains with control contralateral biopsies for lentigo maligna: 5-year follow-up results

Abstract: The use of Slow Mohs formalin-fixed tissue and H&E section staining, even with comparator biopsies, does not provide sufficient discrimination to identify residual disease confidently.

Cited by 27 publications

References 38 publications

Lentigo Maligna and Lentigo Maligna Melanoma: Contemporary Issues in Diagnosis and Management

Lentigo Maligna and Lentigo Maligna Melanoma: Contemporary Issues in Diagnosis and Management

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

Melanocytic soluble adenylyl cyclase protein expression around lentigo maligna and in contralateral control skin

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