Videodermatoscopy‐assisted M ohs micrographic surgery vs. other treatments for lentigo maligna in 54 patients with a long‐term follow‐up

Lentigo maligna (LM) is a relatively common tumour, with increasing prevalence and substantial morbidity.1-3 Cases of LM treated with Mohs micrographic surgery (MMS) have been previously reported as single-centre experiences.4, 5 This retrospective study included patients with a histological diagnosis of LM located on the head and neck area, referred for a surgical procedure to the Skin Cancer Unit, Dermatology, University of Bologna between September 2005 and September 2010. Only cases with at least 5 years of follow-up were included. Patients were divided in three groups: Follow-up was performed every 6 months for the first 5 years.3 A total of 54 patients were included. Twenty-two cases (LM) were treated with MMS; seven cases were treated with VDS-assisted MMS and 25 cases (21 LM, 4 LMM) were treated by conventional surgical excision ( CSE) (Table 1). The three groups were matched as to age and gender. Pre-operative clinical dimensions of the tumours and post-operative defect sizes were similar in each group (Table 1). The differences between MMS and VDS-assisted MMS in reducing the number of steps and the overall timing of the surgical procedure were statistically significant (P = 0.0008, t value of Student's t-test = 3.7632, 27 degrees of freedom). Histologic recurrence was diagnosed in six of 25 cases (24%) treated by CSE and in one of 22 cases treated by MMS. No recurrence was observed in the group of LM treated with VDS-assisted MMS. No distant metastatic disease and no death attributed to melanoma were observed. Recurrence in the group treated with CSE was statistically higher compared to the two groups treated with MMS (classic and VDS-assisted) (P = 0.0405 with Fisher's exact test). In conclusion, to our experience, VDS-assisted MMS proved useful in (i) delineating tumour margins; and (ii) reducing the number of stages and consequently the costs of MMS. This is a single-centre experience with a limited number of patients. Large-scale studies are required to validate adequate margin control techniques reported from various institutions, confronting cost effectiveness of different approaches.7-9 We believe that the combination of VDS-assisted MMS and the use of melanocyte-specific immunostains, as recently proposed 5, 10 could be the gold standard in the treatment of LM.