Six-Year Outcome of Lentigo Maligna Treated With "Spaghetti" Technique and Margin Identification by Reflectance Confocal Microscopy.

IF 2.5 3区医学 Q2 DERMATOLOGY

Dermatologic Surgery Pub Date : 2025-04-01 Epub Date: 2024-12-03 DOI:10.1097/DSS.0000000000004508

Océane Le May, Elisa Cinotti, Jean-Luc Perrot, Linda Tognetti, Julie Chauvel Picard

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引用次数: 0

Abstract

Background: Lentigo maligna (LM) and LM melanoma (LMM) present surgical challenges due to their poorly defined boundaries, making it difficult to determine precise peripheral margins. In addition, their preferential localization on the face increases the need to minimize the amount of tissue excised. Striking a balance between reducing the excision size and maintaining oncologic effectiveness is critical in managing LM/LMM. Reflectance Confocal Microscopy (RCM), a noninvasive imaging method that provides cellular-level visualization, could be an ideal tool to define the peripheral margins in the "spaghetti" surgical technique.

Objective: This study aimed to evaluate the long-term outcomes of using RCM combined with the "spaghetti" technique for LM/LMM excisions.

Materials and methods: Seventy patients with LM/LMM on the face underwent RCM-guided margin definition followed by the "spaghetti" technique. The sample of patients was the same group of patients included in the authors' 2017 study. The authors subsequently evaluated the effectiveness of the authors' protocol via regular follow-up of the cohort.

Results: A total of 59 LMs and 11 LMMs were included. The mean follow-up time was 6.3 years. The recurrence rate was 5.7%. The authors identified 4 recurrences: 3 of which occurred more than 5 years after the procedure. The recorded mortality was 20%, no deaths were attributed to LM/LMM. The mean margin from lesion to clearance was 2.7 mm.

Conclusion: If the authors cluster the 3 principal studies in terms of cohort and follow-up time for LM/LMM treated by Wide local Excision, the recurrence rate is from 5.3% to 5.9%, which is equivalent to the authors'. However, the mean margin excision from lesion is more than 2 times inferior in the authors' protocol (2.7 mm vs 6.7 mm). Therefore, the spaghetti technique with RCM margin identification seems to be an effective method for LM/LMM management.

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“意大利面”技术治疗恶性Lentigo的6年疗效及反射共聚焦显微镜边缘鉴定。

背景：恶性Lentigo （LM）和LM黑色素瘤（LMM）由于其边界不明确，难以确定精确的外周边缘，给手术带来了挑战。此外，它们在面部的优先定位增加了减少切除组织量的需求。在减少切除大小和维持肿瘤疗效之间取得平衡是治疗LM/LMM的关键。反射共聚焦显微镜（RCM）是一种无创成像方法，可提供细胞水平的可视化，可能是“意大利面”手术技术中定义外周边缘的理想工具。目的：本研究旨在评估RCM联合“意大利面”技术在LM/LMM切除术中的远期疗效。材料和方法：70例面部LM/LMM患者采用rcm引导下的边缘定义，然后采用“意大利面”技术。患者样本与作者2017年研究中的同一组患者相同。作者随后通过对队列的定期随访评估了作者方案的有效性。结果：共纳入LMs 59例，LMs 11例。平均随访时间为6.3年。复发率为5.7%。作者确定了4例复发：其中3例发生在手术后5年以上。记录的死亡率为20%，没有死亡归因于LM/LMM。结论：如果作者将3项主要研究从队列和随访时间上对广泛局部切除治疗的LM/LMM进行聚类，复发率为5.3% ~ 5.9%，与作者的结果相当。然而，在作者的方案中，病灶的平均边缘切除比作者的方案低2倍以上（2.7 mm vs 6.7 mm）。因此，具有RCM边际识别的意大利面技术似乎是LM/LMM管理的有效方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Dermatologic Surgery 医学-皮肤病学

CiteScore

3.10

自引率

16.70%

发文量

547

期刊介绍： Exclusively devoted to dermatologic surgery, the Dermatologic Surgery journal publishes the most clinically comprehensive and up-to-date information in its field. This unique monthly journal provides today’s most expansive and in-depth coverage of cosmetic and reconstructive skin surgery and skin cancer through peer-reviewed original articles, extensive illustrations, case reports, ongoing features, literature reviews and correspondence. The journal provides information on the latest scientific information for all types of dermatologic surgery including: -Ambulatory phlebectomy- Blepharoplasty- Body contouring- Chemical peels- Cryosurgery- Curettage and desiccation- Dermabrasion- Excision and closure- Flap Surgery- Grafting- Hair restoration surgery- Injectable neuromodulators- Laser surgery- Liposuction- Microdermabrasion- Microlipoinjection- Micropigmentation- Mohs micrographic surgery- Nail surgery- Phlebology- Sclerotherapy- Skin cancer surgery- Skin resurfacing- Soft-tissue fillers. Dermatologists, dermatologic surgeons, plastic surgeons, oculoplastic surgeons and facial plastic surgeons consider this a must-read publication for anyone in the field.