Lentigo maligna of the head and neck. Results of treatment by radiotherapy.

BACKGROUND AND DESIGN: Although surgical excision is considered the treatment of choice for lentigo maligna, some elderly patients presenting with large lesions in the head and neck region may not be suitable candidates for surgical management. Radiotherapy has been used for this tumor at the Princess Margaret Hospital, Toronto, Ontario, for over the past 20 years with encouraging results. Fifty-four patients treated between 1968 and 1988 were identified, and their records were reviewed to determine treatment outcome.

RESULTS: Younger patients with smaller lesions were treated with surgical excision (n = 18) and achieved an actuarial tumor control rate of 94% at 3 years. Older patients with larger lesions located in the head and neck area were treated by radiotherapy (n = 36), with an actuarial tumor control rate of 86% at 5 years. Three of the four patients not achieving tumor control by radiation were successfully treated with surgical excision, and two of them proved to have malignant melanomas (both Clark's level II) when examined histologically. One patient with residual pigmentation 4 months after treatment 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 progressive skin pallor, atrophy, and telangiectasia in the treated area.

CONCLUSION: Conventional fractionated radiation therapy with superficial x-rays is a simple and effective method of management for lentigo maligna of the head and neck region. It is an excellent alternative treatment to surgical excision, with low morbidity and acceptable long-term cosmetic results.