The perimeter technique for lentigo maligna: An alternative to Mohs micrographic surgery

Background: Lentigo maligna (LM) presents a challenge for complete surgical excision because of its extensive subclinical spread and predilection for the face. Objective: To report our experience using the staged perimeter technique as an alternative to Mohs micrographic surgery for treatment of LM. Methods: The perimeter procedure was performed on 11 patients with LM between March 2003 and June 2004. Data on patient and lesion characteristics, number of stages required to obtain clear margins, and follow-up was obtained by chart review. Results: A mean of 1.9 stages were required to achieve clear margins. A mean of 7 tissue specimens were sent to pathology per patient for evaluation. After a mean follow-up of 4.7 months, all patients were free of recurrence. Conclusions: The perimeter technique is a simple method of margin-controlled excision of LM. The main advantage is that all margins are examined with permanent sections. The main drawback is that multiple operative sessions are required to complete the procedure. This technique does not require specific Mobs training and is therefore applicable to non-Mohs surgeons. (c) 2005 Wiley-Liss, Inc.