Variation in the diagnosis and clinical management of Lentigo Maligna across Europe: a survey study among EADV members

Abstract

Background

Lentigo maligna (LM), a form of melanoma in situ, is treated to prevent progression to lentigo maligna melanoma (LMM). Surgical treatment is the gold standard. However, treatment guidelines are based on expert opinion and comparative studies are lacking.

Objective

The objective of this study is to assess the diagnostic methods and clinical management of LM patients among European dermatologists and residents.

Methods

A survey consisting of 29 questions about diagnostic methods and treatment options used for LM patients was sent to 3308 members of the European association of Dermatologists and Venereologists (EADV).

Results

Most questions were multiple choice, and multiple answers could be ticked per question.

A total of N = 415 (12.5%) completed surveys were included into the analyses. A combination of clinical diagnosis 65.7%, dermatoscopy 83.4% and histopathology 88.2% is used by most respondents to diagnose LM. Tissue for histopathological evaluation was collected using most often by a single punch biopsy in 61.0%, The most common treatment for LM patients <60 years of age is surgery (97,6%). For LM patients >70 years of age, 66.8% of the respondents preferred surgical treatment. Non-surgical options such as radiotherapy (17.0%), topical imiquimod (30.6%), watchful waiting (19.6%) or cryotherapy (20.4%) were used in this elderly group. Sub-analysis showed that respondents who take into account patient preference, used topical imiquimod, radiotherapy and watchful waiting more often.

Conclusion

In conclusion, the results of this survey show that there is a variance in the diagnostic methods and treatment modalities used for LM across Europe. Surgery remains the most utilized option. However, non-surgical options, such as topical imiquimod and radiotherapy, are most often used for elderly patients. We recommend that future studies focus on patient preference and compare surgical to non-surgical therapy.

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