Review of Tumor Margins for Lentigo Maligna with Staged Surgical Excision and Permanent Section en face Processing

Background: The optimal surgical margins required for the excision of lentigo maligna remains a topic of debate. Recent literature suggests that wider margins are warranted. Objective: Comparison of lentigo maligna margin sizes and clearance rates from a single center to existing literature. Methods: A retrospective analysis of primary and recurrent lentigo maligna treated by staged excision with complete circumferential and deep margin assessment between 2011 and 2023 at a single institution was conducted. The percentage of tumors with clear margins after the initial excision with 5 mm margins was determined. Results: A total of 65 tumors were identified. Fifty-eight patients (89.2%) had clear margins after initial excision with 5 mm margins.  Conclusions: This study reports a higher percentage of lentigo maligna clearance following the initial staged excision with 5 mm margins than reports in the literature. These differences may be attributed to variations in section processing, staining techniques, and factors associated with differences in subclinical spread.