Overview
Melanoma in situ, including lentigo maligna, represents the earliest stage of melanoma confined to the epidermis without invasion. Early detection and management are crucial to prevent progression to invasive melanoma.Diagnosis
Clinical examination: Essential component in diagnosis 1.
Dermatoscopy: Widely utilized to aid in distinguishing from benign lesions 1.
Histopathology: Confirmatory test, often obtained via punch biopsy 1.
Combination approach: Most effective when clinical diagnosis, dermatoscopy, and histopathology are used together 1.Management
Surgical excision: Gold standard treatment, particularly for patients under 60 years 1.
Consideration for elderly: For patients over 70 years, surgical preference varies; non-surgical options may be considered in some cases 1.
No specific drug therapy: Management primarily relies on surgical intervention without mention of systemic treatments 1.Special Populations
Elderly patients: Treatment preferences diverge; surgical intervention is less uniformly recommended for those over 70 years 1.Key Recommendations
Utilize a combination of clinical examination, dermatoscopy, and histopathology for accurate diagnosis of lentigo maligna (Evidence: Moderate 1).
Surgical excision is recommended as the primary treatment for patients under 60 years of age with lentigo maligna (Evidence: Expert opinion 1).
For patients over 70 years, individualized treatment decisions should consider surgical versus non-surgical options due to varying clinical preferences (Evidence: Expert opinion 1).References
1 Tio D, Prinsen CAC, Dréno B, Hoekzema R, Augustin M, van Montfrans C. Variation in the diagnosis and clinical management of lentigo maligna across Europe: a survey study among European Association of Dermatologists and Venereologists members. Journal of the European Academy of Dermatology and Venereology : JEADV 2018. link