BACKGROUND: Lentigo maligna (LM) is a therapeutic challenge for surgeons because of its location in aesthetic areas and the difficulty in determining margins. OBJECTIVE: To investigate a new procedure combining the "spaghetti" technique described by Gaudy-Marqueste and colleagues in 2011 with in vivo reflectance confocal microscopy (RCM) to define the margins of LM more accurately and allow strict histologic control. METHODS AND MATERIALS: Thirty-three consecutive patients with LM of the head underwent a RCM-guided delineation of the margins followed by the "spaghetti" technique. RESULTS: The excision of the first "spaghetti" in a tumor-free area was obtained in 28 of 33 patients. In the other five cases, persistence of LM foci was found in <5% of the length of spaghetti. The average number of pieces of "spaghetti" was 1.2 (range 1-3). Definitive histologic examination of the lesion showed a minimum average margin of 2.7 mm. Follow-up in 27 patients after an average of 10 months (range 4-25 months) did not show any recurrence. CONCLUSION: This procedure allows accurate definition of the surgical margins of LM, with a low rate of multiple excisions, sparing tissue in functional and aesthetic areas. These results should be confirmed on the basis of a larger series with longer follow-up.
BACKGROUND:Lentigo maligna (LM) is a therapeutic challenge for surgeons because of its location in aesthetic areas and the difficulty in determining margins. OBJECTIVE: To investigate a new procedure combining the "spaghetti" technique described by Gaudy-Marqueste and colleagues in 2011 with in vivo reflectance confocal microscopy (RCM) to define the margins of LM more accurately and allow strict histologic control. METHODS AND MATERIALS: Thirty-three consecutive patients with LM of the head underwent a RCM-guided delineation of the margins followed by the "spaghetti" technique. RESULTS: The excision of the first "spaghetti" in a tumor-free area was obtained in 28 of 33 patients. In the other five cases, persistence of LM foci was found in <5% of the length of spaghetti. The average number of pieces of "spaghetti" was 1.2 (range 1-3). Definitive histologic examination of the lesion showed a minimum average margin of 2.7 mm. Follow-up in 27 patients after an average of 10 months (range 4-25 months) did not show any recurrence. CONCLUSION: This procedure allows accurate definition of the surgical margins of LM, with a low rate of multiple excisions, sparing tissue in functional and aesthetic areas. These results should be confirmed on the basis of a larger series with longer follow-up.
Authors: Brian P Hibler; Oriol Yélamos; Miguel Cordova; Heidy Sierra; Milind Rajadhyaksha; Kishwer S Nehal; Anthony M Rossi Journal: Cutis Date: 2017-05
Authors: Oriol Yélamos; Miguel Cordova; Nina Blank; Kivanc Kose; Stephen W Dusza; Erica Lee; Milind Rajadhyaksha; Kishwer S Nehal; Anthony M Rossi Journal: JAMA Dermatol Date: 2017-12-01 Impact factor: 10.282
Authors: Samantha L Schneider; Indermeet Kohli; Iltefat H Hamzavi; M Laurin Council; Anthony M Rossi; David M Ozog Journal: J Am Acad Dermatol Date: 2018-12-04 Impact factor: 11.527
Authors: Yannick S Elshot; Biljana Zupan-Kajcovski; William M C Klop; Marcel W Bekkenk; Marianne B Crijns; Menno A de Rie; Alfons J M Balm Journal: Head Neck Date: 2020-11-24 Impact factor: 3.147