Source:

Journal of the Dermatology Nurses' Association

April 2010, Volume 2 Number 2 , p 84 - 84 [FREE]

Authors

  • Indira Singh PCT
  • Doris Alleyne Hall RN

Abstract

This poster discusses the surgical treatment of lentigo maligna melanoma (LMM) via staged excision with permanent sections. This technique goes beyond the standard surgical excision with 5-mm margins to assess any subclinical extension prior to reconstruction, resulting in low recurrence rates.We reviewed literature on lentigo maligna and LMM, variations on surgical treatment, and recurrence rates, with a focus on surgical techniques that utilize peripheral margin assessment prior to cosmetic repair.The most common techniques for LMM removal are Mohs micrographic surgery and staged excisions with permanent sections. Because Mohs micrographic surgery relies on frozen sections, the results are subject to interpretation. Staged excisions allow for definitive results with the lowest recurrence rates.Although techniques are varied, the most advantageous are those that excise the clinical lesion and take a surgical margin on the initial procedural date for histological assessment. This enables

INTRODUCTION

 

This poster discusses the surgical treatment of lentigo maligna melanoma (LMM) via staged excision with permanent sections. This technique goes beyond the standard surgical excision with 5-mm margins to assess any subclinical extension prior to reconstruction, resulting in low recurrence rates.

METHODS

 

We reviewed literature on lentigo maligna and LMM, variations on surgical treatment, and recurrence rates, with a focus on surgical techniques that utilize peripheral margin assessment prior to cosmetic repair.

RESULTS

 

The most common techniques for LMM removal are Mohs micrographic surgery and staged excisions with permanent sections. Because Mohs micrographic surgery relies on frozen sections, the results are subject to interpretation. Staged excisions allow for definitive results with the lowest recurrence rates.

CONCLUSION

 

Although techniques are varied, the most advantageous are those that excise the clinical lesion and take a surgical margin on the initial procedural date for histological assessment. This enables dermatologists to offer the best rates of LMM removal with anatomical and cosmetic considerations. Although removal and reconstruction can take 1 week to a number of weeks, facilities that can accommodate 24-hour rush pathology can expedite the process and reduce patient anxiety.

NURSING IMPLICATIONS

 

A pressure dressing to reduce bleeding and keep the wound moist is applied, and wound care instructions are given.

 

1. Xeroform Petrolatum Gauze and Bactroban ointment are applied to the wound defect.

 

2. Pressure dressing consisting of Telfa and gauze are applied over the Xeroform and secured with paper tape.

 

3. The patient is told to keep the dressing clean, dry, and intact until patient returns.

 

4. The patient is instructed on the signs and symptoms of bleeding, infection, and pain.

 

REFERENCES

 

Bene, I., Healy, C., & Coldiron, B. M. (2008). Mohs micrographic surgery is accurate 95.1% of the time for melanoma in situ: A prospective study of 167 cases. Dermatologic Surgery, 34, 660-664.

 

Clark, G. S., Pappas-Politis, E. C., Cherpelis, B. S., Messina, J. L., Moller, M. G., Cruse, C. W., et al. (2003). Surgical management of melanoma in situ on chronically sun-damaged skin. Cancer Control, 15(3), 216-224.

 

Demierre, M. F., Allen, S., & Brown, R. (2005). New treatments for melanoma: Chemoprevention of melanoma. Dermatology Nursing, 17(4), 287-295.

 

Hazan, C., Duszu, S. W., Delgado, R., Busam, K. J., Halpern, A. C., & Nehal, K. S. (2007). Staged excision for lentigo maligna and lentigo maligna melanoma: A retrospective analysis of 117 cases. Journal of the American Academy of Dermatology, 58, 142-148.

 

Khachemoune, A., & Ehrsam, E. (2005). Assessing malignant melanoma: A case study. Dermatology Nursing, 17(3), 188-190.

 

McKenna, J. K., Florell, S. R., Goldman, G. D., & Bowen, G. M. (2006). Lentigo maligna/Lentigo maligna melanoma: Current state of diagnosis and treatment. Dermatologic Surgery, 32, 493-504.