Ultraviolet-assisted punch biopsy mapping for lentigo maligna melanoma

Lentigo maligna melanoma (LMM) accounts for a substantial incidence of all locally recurrent melanoma. In addition, the head and neck area accounts fo r 60% to 90% of all LMMs, which has important functional and cosmetic impli cations. The difficulty in the identification of the true borders of LMM ma y account for the high incidence of local recurrence. The purpose of this s tudy was to evaluate the efficacy of ultraviolet-assisted punch biopsy mapp ing to identify clear margins using identified, 2-mm circumferentially arra nged punch biopsies at the junction of the pigmented and nonpigmented borde rs, A retrospective chart review of 20 patients with biopsy-confirmed LMM o f the head and neck was performed, Using ultraviolet identification, 2-mm c ircumferentially arranged biopsy specimens were obtained and sent for forma l pathological review, including immunohistochemical staining, The average time for completion of pathological review was 5 to 7 days. If the punch bi opsies were positive for lentigo maligna or LMM, punch biopsies were obtain ed more peripherally. Once clear, margins were obtained and definitive rese ction was performed. Twenty patients with biopsy-proved LMM were evaluated. Follow-up ranged from 6 months to 3 years (mean follow-up, 1 year). Fourte en patients were cleared after their first series of biopsies, 3 patients r equired a second series of biopsies, 2 patients required a third session, a nd 1 patient required a fourth biopsy session. To date, there has been no e vidence of recurrence, No patients required reexcision for positive surgica l margins, One complication has been local cellulitis of a punch biopsy sit e requiring a short course of antibiotics. Ultraviolet-assisted punch biops y mapping of LMM is a safe, well-tolerated, and accurate technique for iden tifying the true histological margin of LMM, The procedure reduces the need for repeat surgical excisions to obtain clear margins and may decrease the risk for recurrence by mapping accurately the true histological margin.