LM and LMM will be considered separately. Lentigo maligna
Surgery: There have been no RCTs of patients in this category. A comparative study of 42 cases of LM showed a recurrence rate of 9% (2/22) following surgical excision, compared with 35% (7/20) with other techniques such as radiotherapy, curettage and cryotherapy surgery, with a mean follow up period of 3-5 years (range 1 month to 11 years).22 A further retrospective report of 38 cases of LM suggested cure rates of 91% (two recurrences) over a time period of 1-12 years (mean 3 years).23 Mohs' micrographic surgery has also been evaluated in small numbers of patients, usually with excellent results. Twenty-six patients with LM were treated in one study, with no recurrences after a median follow up of 58 months.24
Cryotherapy: There have been no RCTs of cryotherapy for the treatment of LM. One study of 30 patients reported recurrence rates of 6-6% (two patients) in a follow up period of 3 years. Eleven patients who were observed for more than 5 years had no recurrences.25 A further study of 12 patients showed a recurrence rate of 8-3% over a follow up period of 51 months.26
Radiotherapy: There have been no RCTs of radiotherapy for LM. One case series reported two recurrences in 68 patients with a 5-year follow up.27 A further study showed an 86% cure rate in 36 patients at 5 years.28
Other treatments: There have been a few case reports on the use of various lasers in LM but the numbers are too small to be conclusive. A study of 5-fluorouracil cream showed 100% recurrence rate29 and a similar study on topical retinoic acid showed no benefit.30 Azelaic acid was reported to give recurrence rate of 22% in 50 patients, all of whom subsequently cleared with retreatment.31
Surgery: Patients with LMM have not been included in any of the large randomised trials on surgical margins. However, it has been shown that the prognosis for patients with invasive LMM is the same as that for any other type of melanoma when matched for thickness.32 Patients with LMM were included in a case series of Mohs' micrographic surgery, which found a 100% cure rate after 29 months and a 97% cure rate after 58 months.24
Radiotherapy: An uncontrolled follow up study of fractionated radiotherapy in both LM and LMM showed that of 64 patients with LM, none showed any signs of recurrence. Among 22 patients with LMM who also had the nodular part of the lesion excised, there were two recurrences. The mean follow up period was 23 months.33
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