Lentigo Maligna Melanoma

Lentigo maligna melanoma is an increasingly common melanoma subtype worldwide, occurring mainly on the head and neck of older, lightskinned individuals. This subtype poses specific challenges in diagnosis and management, including histologic differentiation from surrounding sun-damaged skin with atypical melanocytes, optimizing treatment in anatomically constrained sites where this melanoma subtype tends to occur, and reducing local recurrence rates related to subclinical extensions, all while taking into account quality of life issues and suitability of surgical, topical, and/or radiation therapy in an elderly population. Noninvasive tools such as dermoscopy and reflectance confocal microscopy can facilitate early diagnosis. Treatment options include surgical and nonsurgical modalities which are complicated by frequent subclinical extension of the tumor and more complex anatomic location. Surgical options include conventional wide excision and techniques that provide exhaustive peripheral margin control, including staged excision with permanent sections and Mohs micrographic surgery, both of which may reduce rates of local recurrence. Nonsurgical therapies include off-label topical imiquimod and radiation therapy, which are generally second-line but may be preferable in certain instances based on patient comorbidities and/or limited life expectancy, quality of life issues, and/or preference for nonsurgical treatment. Recurrence may occur years after initial treatment, necessitating the need for long-term follow-up.