LENTIGO MALIGNA OF THE HEAD AND NECK - RESULTS OF TREATMENT BY RADIOTHERAPY

Background and Design: Although surgical excision is considered the tr eatment of choice for lentigo maligna, some elderly patients presentin g with large lesions in the head and neck region may not be suitable c andidates for surgical management. Radiotherapy has been used for this tumor at the Princess Margaret Hospital, Toronto, Ontario, for over t he past 20 years with encouraging results. Fifty-four patients treated between 1968 and 1988 were identified, and their records were reviewe d to determine treatment outcome. Results: Younger patients with small er lesions were treated with surgical excision (n=18) and achieved an actuarial tumor control rate of 94% at 3 years. Older patients with la rger lesions located in the head and neck area were treated by radioth erapy (n=36), with an actuarial tumor control rate of 86% at 5 years. Three of the four patients not achieving tumor control by radiation we re successfully treated with surgical excision, and two of them proved to have malignant melanomas (both Clark's level II) when examined his tologically. One patient with residual pigmentation 4 months after tre atment was unavailable for follow-up. No patients developed metastatic melanoma. The late cosmetic appearance was acceptable in the majority of irradiated patients, with 11% showing poor cosmesis due to progres sive skin pallor, atrophy, and telangiectasia in the treated area. Con clusion: Conventional fractionated radiation therapy with superficial x-rays is a simple and effective method of management for lentigo mali gna of the head and neck region. It is an excellent alternative treatm ent to surgical excision, with low morbidity and acceptable longterm c osmetic results.