Comment

The evidence that narrow surgical margins are as beneficial as more extensive surgical treatment in terms of local recurrence and survival is reasonably strong. The studies have suggested that lesions <1 mm in depth can be safely treated with surgical margins of 1 cm and lesions equal to or >1 mm in depth can be safely treated with margins of 2 cm. There is also evidence from one observational study that 2 cm margins are also sufficient for thicker tumours.

MM <0-75 mm in depth have not been studied in any controlled trials, nor have lesions >4 mm in depth. Melanoma in situ, where the melanoma cells are confined to the epidermis, appear to have no potential for metastatic spread19 and the current consensus based on empirical reasoning is that it is safe to excise such lesions with a margin of 5 mm of clinically normal skin to obtain a clear histological margin.20

How should patients with lentigo maligna or lentigo maligna melanoma be managed?

Lentigo maligna (LM) is the premalignant phase of lentigo maligna melanoma (LMM), where the malignant melanocytes are entirely confined to the epidermis. These usually occur on sun-exposed sites such as the face and neck. There is usually a prolonged premalignant phase before dermal invasion and the development of LMM. The lesions are difficulty to manage for several reasons. Patients with these lesions tend to be elderly, with other comorbidities that may limit extensive surgery. The lesions themselves may be large and occur close to important anatomical structures and therefore full surgical excision with suitable margins may be difficult or even impossible. In addition, histological changes within the epidermis may occur at some distance from the clinically obvious margins.21

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