Histologic margin status can help predict lentigo maligna melanoma recurrence
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Key takeaways:
- Histologic margin status is a predictor of lentigo maligna melanoma progression.
- In a univariate analysis, age of 71 years and older was correlated with worse overall survival and progression-free survival.
The strongest predictor of lentigo maligna melanoma progression is histologic margin status, and patients with margins less than 3 mm should consider re-excision, according to a study.
“Lentigo maligna (LM, in situ) and lentigo maligna melanoma (LMM, invasive) is a subtype of melanoma occurring on sun-damaged skin and with increased incidence with age,” Mai P. Hoang, MD, of Massachusetts General Hospital and Harvard Medical School, and colleagues wrote. “LM/LMM poses a treatment challenge due to multiple factors, including frequent head and neck location, large clinical size and propensity for recurrence.”
Hoang and colleagues identified 268 invasive LMM cases between 1990 and 2019 at Massachusetts General Hospital and extracted data regarding demographics, tumor site, Clark level, Breslow thickness, presence of ulceration, dermal mitosis per millimeter squared and other factors as well as disease status over time and outcome at last follow-up.
Tumor location was most often on the head and neck (76%), with upper extremity and shoulder (11%), trunk (9%) and lower extremity and hip (4%) following.
Wide local excision and staged excision were conducted on 88.1% and 11.9% of patients, respectively.
In 54 patients (20.1%), progression developed, with local recurrence in 36 patients (13.4%) and subsequent metastasis and local recurrence in seven patients (2.6%).
Margin status of the primary tumor was positive in 20 of the 54 patients who relapsed, less than 3 mm in nine patients and negative in 25 patients.
Using univariate analysis, age of 71 years and older, stage II, Clark level, thickness and dermal mitosis were all correlated with worse overall survival and worse progression-free survival.
“Our data show that histologic margin status (positive and close/less than 3 mm) is the strongest predictor of LMM progression (either recurrence or metastasis),” the authors wrote. “Patients with positive or close/less than 3 mm histological margins should consider a re-excision due to the increased risk of progressive disease.”
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