Surgical Treatments for Lentigo Maligna: A Review

BACKGROUND Since its initial description by Jonathan Hutchinson 120 years ago, a substantial amount of research has occurred to determine the optimum surgical therapy for lentigo maligna (LM). OBJECTIVE To summarize the literature regarding the surgical treatment of LM. METHODS We searched the National Library of Medicine using Pubmed Central and MEDLINE and included as many investigational reports regarding LM therapy that were available in an attempt to form a comprehensive review of surgical modalities. The key words lentigo maligna, lentigo maligna treatment, lentigo maligna therapy, and lentigo maligna therapeutic modalities were used. RESULTS We included 12 studies examining staged surgical excision (SSE), nine using Mohs micrographic surgery (MMS), six investigating cryosurgery, 22 investigating imiquimod, seven using lasers, nine investigating radiation therapy, and two investigating electrosurgery and curettage. CONCLUSIONS SSE and MMS are associated with the lowest recurrence rates for LM. Cryotherapy and radiation therapy may be considered the options for treatment of LM in patients who cannot tolerate surgery. Imiquimod, although not currently approved by the FDA, has shown some efficacy in limited experimental studies and may play a future role in the treatment of LM. The authors have indicated no significant interest with commercial supporters.