Lentigo maligna melanoma of the face: Clinical insights from a case of recurrence following surgical excision

Abstract

Background

Lentigo maligna (LM) and lentigo maligna melanoma (LMM) are the most prevalent subtypes of melanoma, primarily affecting sun-exposed areas of the face in individuals aged 65 to 80 years. LM accounts for approximately 80 % of in situ melanomas and carries a risk of progression to LMM, which constitutes 4 % to 15 % of global cutaneous melanoma cases. This report discusses the clinical challenges and management strategies for recurrent LM, with an emphasis on accurate diagnosis and surgical intervention.

Case presentation

A 71-year-old female presented with a pigmented lesion on her left cheek that had recurred after excision six years earlier. Histopathological examination confirmed a diagnosis of LMM, revealing atypical melanocytes and solar elastosis. The lesion was surgically excised using the rotation flap technique, resulting in favorable aesthetic outcomes and no recurrence at the six-month follow-up.

Discussion

The paper highlights the slow growth of LM and a 3.5 % annual risk of progression to LMM. Surgical excision remains the preferred treatment, necessitating a minimum margin of 5 mm due to a 20 % local recurrence rate, which is particularly challenging for facial lesions. The limitations of radiotherapy as an adjunctive treatment are acknowledged, given the high recurrence rates associated with this approach.

Conclusion

This research underscores the complexities involved in managing LM and LMM, connecting them to chronic sun exposure and the associated risk of invasive melanoma. It emphasizes the necessity for accurate diagnosis and sufficient surgical excision to minimize recurrence rates. Furthermore, it highlights racial disparities in incidence, advocating for tailored prevention strategies and ongoing research into effective treatment protocols and adjunctive therapies to improve patient outcomes.