Non-surgical treatments for lentigo maligna recommendations

  • Nonsurgical therapy for primary cutaneous melanoma should only be considered under select clinical circumstances, when surgical excision is not feasible.
  • Alternatives to surgery include topical imiquimod, radiation therapy, cryosurgery, and observation.
  • Efficacy of nonsurgical therapies for lentigo maligna has not been fully established.

Strength of Recommendations: C Level of Evidence: III 

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For all stages of primary cutaneous melanoma, from in situ disease to a deeply invasive tumor, surgical excision remains the standard of care. However, for the treatment of lentigo maligna alternative therapies may be considered when surgery is not a reasonable option because of patient comorbidities or preferences. The limitations of all nonsurgical treatment modalities must clearly be discussed with patients when considering any alternative therapies, including the risk of missing and undertreating invasive melanoma by not microstaging the primary lesion; higher local recurrence rates because of a lack of margin control; and the absence of long-term, randomized, controlled comparative studies.

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