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Reflectance confocal microscopy enhanced treatment of patients with lentigo maligna

In vivo reflectance confocal microscopy provided valuable details in supporting optimal diagnoses and management of patients with lentigo maligna, according to study results.

Researchers studied 37 patients (mean age, 71 years; 26 women) with lentigo maligna (LM; n=32) or LM melanoma (LMM; n=5) from two tertiary referral melanoma centers in Sydney, Australia. All were mapped with in vivo reflectance confocal microscopy (RCM). Patients had large facial lesions requiring complex reconstructive surgery and/or recurrent or poorly delineated lesions at other body locations. Researchers used RCM LM scores to obtain RCM images in four radial directions for LM margin delineation.

Main outcome measures included variations in the margin of LM, based on either RCM, dermoscopy or histopathologic analysis.

RCM identified subclinical disease more than 5 mm beyond the dermoscopy margin (defined as beyond published recommended excision margins) in 17 of 29 patients with dermoscopically visible lesions. During a median follow-up of 37 months, clinicians changed case management of 27 patients based on RCM findings; 11 patients had a major change in surgical procedure, and 16 were offered radiotherapy or imiquimod. Seventeen patients had surgical treatment. Two patients with LM cheek lesions larger than 6 mm had surgical excision margins that were histopathologically involved, according to RCM-delineated margins.

“RCM is a noninvasive imaging technique likely to enhance the accuracy of clinical diagnosis of LM and delineate its margins,” the researchers concluded. “It may also help to guide overall case management. Furthermore, the information obtained by this technique can assist multidisciplinary medical teams in their management of difficult and challenging cases.”