Dr Stevens explains the advantages of using the latest diagnostic technology, not least confocal microscopy.
Lentigo maligna is a subtype of melanoma, which initially occurs in the epidermis, the upper layer of the skin. A slowly growing patch similar to concentrated freckles, or sun spots is common, although appearance can vary.
The patch typically expands over time and further symptoms may develop if left untreated, from irritation, to a harder, or crusty surface, perhaps bleeding. More significantly, the condition can change from being unsightly, to dangerous.
A good proportion will remain as ‘in situ’ melanoma, confined to the epidermis but other cases may develop into lentigo maligna melanoma. This can spread to deeper skin layers and ultimately other organs, in the same way as malignant melanoma.
Detailed, professional examination is important at as early a stage as possible, to reduce risk and the amount of treatment needed.
Consultation & Diagnosis
Assessment naturally includes understanding how you feel about the condition, your medical history, previous sun exposure and defining individual treatment needs.
One of our consultant dermatologists will examine the lesion(s), with a skilled eye and often with a dermascope. A hand held, skin surface microscope, with a built in, high resolution video camera.
A need to take small biopsies is possible, although Skin Care Network consultants often use an alternative, to examine layers of your skin at cellular level.
We are the only private UK dermatology clinic with a reflectance confocal microscope. A tool which increases accuracy, reduces biopsies, helps to identify precise treatment options for lentigo maligna patients and lessens scarring.
All imagery, or tissue analysis needs to be allied with a consultant’s experience. Laser based reflectance confocal microscopy is nevertheless a remarkable advance, to avoid biopsies and support treatment.
A small scale (October 2017) study at the Memorial Sloan Kettering Cancer Center focused on lentigo maligna and the use of confocal imaging. They noted improved accuracy in detecting the margin of healthy skin needing to be removed and better pre operative planning.
In 2019, wider research took place, to produce evidence based, clinical practice guidelines for the management of lentigo maligna. This concluded that “the use of peri-operative reflectance confocal microscopy to assess margins should be considered when available.”
Our experience matches these benefits in practice and the approach gives patients a better understanding of the likely aesthetic outcome of treatment.
Treating Lentigo Maligna
As a condition with fairly high risk of recurrence, removing lesions with a margin of healthy tissue is logical. With most lesions on the face, we do however consider an alternative.
Mohs surgery is an advanced technique, designed to remove just the right amount of tissue to include cancerous cell but no more. “Slow Mohs” is a modified form, well suited to and recommended for Lentigo maligna treatment
The benefit slow Mohs offers have been highlighted at international dermatology conferences and in clinical research. Further recent research on treating lentigo maligna shows the advantages of standard Mohs surgery.
With a specialist Mohs team in house, the approach best suited to your case is available at our London clinic. Normal tissue is spared, lessening cosmetic repair of any resulting wound. A skin graft could still be needed but the likelihood is reduced, yet the cure rate is high.
There may be situations where surgery is not feasible. Radiotherapy, cryotherapy, or topical treatments are options, although as with any melanoma treatment, the surgical removal of lentigo maligna is preferred and sensible with the latest techniques.
Support At Skin Care Network
You can be certain our consultants will give your skin cancer treatment personal attention and advise on the best way forward. If you do need Lentigo maligna treatment in London, they can also arrange long term follow up, a wise precaution.
Good support staff and the latest diagnostic, or surgical equipment are further assets, although we believe the relationships we build with patients are the key to successful care.
If you have concerns about your skin, we would be pleased to hear from you and promise to treat you as the individual you are.