In the absence of any controlled trials, it is not surprising that a recent survey of dermatologists has shown a wide variation in treatment modalities in use in the UK. An algorithm was devised on the basis of the current treatments for LM suggesting that surgical resection was the initial treatment of choice if possible, and Mohs' surgery when the margins were unclear. For those lesions that are not amenable to surgical resection, radiotherapy or cryotherapy may be suitable choices. There is an absence of information on the rate of progression of LM, and in the very old and infirm observation only may be considered appropriate.34 As the prognosis of LMM is the same as any other MM when matched for Breslow thickness, the same surgical margins should be advised whenever possible until better evidence becomes available.
There is some evidence to show that lymph node dissection is beneficial when performed when there is evidence of metastatic spread. However, there is still some controversy about the place of elective lymph node dissection where there are no clinically involved lymph nodes.
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