Abstract
EXPLORING THE BORDERS – Diagnosis and surgical treatment of lentigo maligna
This thesis demonstrates the increasing incidence of cutaneous melanomas in the Netherlands. The largest proportion of the cutaneous melanomas are in situ or thin melanomas. Possible explanations of this increase include a true increase, in conjunction with ‘overdiagnosis’ caused by increased awareness, early detection and diagnostic drift. Lentigo maligna (LM) is the most common in situ melanoma subtype and accounts for three quarters of all in situ melanomas.
Retrospective, prospective, and national data show that upstaging to LMM occurs in approximately one of ten patients after surgery. This should be taken into account when making therapeutic decisions, especially when non-surgical treatments are being considered. Evaluating LM on frozen sections with additional staining is possible and should be further explored in the future to incorporate in daily practice and improve the tolerability of the surgical treatment of LM. Treating LM remains a therapeutic challenge due to its predominance in the face and in elderly patients. Surgical treatment is generally recommended, though striving for clear margins may not always be necessary, and a ‘wait and see’ approach should be considered in some cases. Future research should consider integrating frailty screening and focus on developing tools to support shared decision-making prior to treatment. In conclusion, the treatment of LM is challenging and there is no one-size-fits-all solution.
This thesis demonstrates the increasing incidence of cutaneous melanomas in the Netherlands. The largest proportion of the cutaneous melanomas are in situ or thin melanomas. Possible explanations of this increase include a true increase, in conjunction with ‘overdiagnosis’ caused by increased awareness, early detection and diagnostic drift. Lentigo maligna (LM) is the most common in situ melanoma subtype and accounts for three quarters of all in situ melanomas.
Retrospective, prospective, and national data show that upstaging to LMM occurs in approximately one of ten patients after surgery. This should be taken into account when making therapeutic decisions, especially when non-surgical treatments are being considered. Evaluating LM on frozen sections with additional staining is possible and should be further explored in the future to incorporate in daily practice and improve the tolerability of the surgical treatment of LM. Treating LM remains a therapeutic challenge due to its predominance in the face and in elderly patients. Surgical treatment is generally recommended, though striving for clear margins may not always be necessary, and a ‘wait and see’ approach should be considered in some cases. Future research should consider integrating frailty screening and focus on developing tools to support shared decision-making prior to treatment. In conclusion, the treatment of LM is challenging and there is no one-size-fits-all solution.
| Original language | English |
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| Award date | 7 Jan 2026 |
| Place of Publication | Rotterdam |
| Print ISBNs | 978-94-6534-067-8 |
| Publication status | Published - 7 Jan 2025 |