Dermatologic SurgeryHistologic evaluation of lentigo maligna with permanent sections: Implications regarding current guidelines☆,☆☆,★
Section snippets
Methods
All patients were evaluated at the University of Utah Health Sciences Center, Department of Dermatology, from July 1, 1994, to October 15, 2000. Two Mohs surgeons and one Mohs fellow performed the excisions. Two board-certified dermatopathologists interpreted the slides. Ninety-two consecutive patients with a diagnosis of MIS, LM type, were enrolled. Demographic data demonstrated ages ranging from 24 to 100 years (median age, 70 years) with 37% female and 63% male. All patients were Caucasian.
Results
In the group of 93 patients studied, 69 (75%) of the tumors were found on the head and neck, and 23 (25%) were found elsewhere. Sites on the head and neck, in decreasing frequency, were the cheeks, nose, forehead and temple, ears, neck, scalp, and chin. Of the 25% of the remaining lesions in sites other than the head and neck, 50% were on the extremities, 42% were on the trunk, and 8% were in acral areas. With staged excisions, 39 (42%) were clear after one stage, 25 (27%) required 2 stages, 14
Discussion
Use of permanent sections removed in straight-edged polygons around LM is a reliable and reproducible method for identifying tumor-free margins. Submission and evaluation of the center portion may reveal an otherwise unsuspected invasive component. Many approaches to removal of LM in a staged manner have been reported. Such approaches vary in slight ways in both philosophy and technique but have evolved to achieve the same goal: verifying clear peripheral and deep margins for LM before a repair
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Funding sources: None.
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Conflict of interest: None.
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Reprint requests: John W. Gerwels, MD, University of Utah, Department of Dermatology, 50 N Medical Dr, Salt Lake City, UT 84132.