Dermatology practical & conceptual · 2023
Delphi Consensus Among International Experts on the Diagnosis, Management, and Surveillance for Lentigo Maligna.
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Longo Caterina, Navarrete-Dechent Cristian, Tschandl Philipp, Apalla Zoe, Argenziano Giuseppe, Braun Ralph P, Bataille Veronique, Cabo Horacio, Hoffmann-Wellhenhof Rainer, Forsea Ana Maria, Garbe Claus, Guitera Pascale, Raimond Karls, Marghoob Ashfaq A, Malvehy Josep, Del Marmol Veronique, Moreno David, Nehal Kishwer S, Nagore Eduardo, Paoli John, Pellacani Giovanni, Peris Ketty, Puig Susana, Soyer H Peter, Swetter Susan, Stratigos Alexander, Stolz Wilhelm, Thomas Luc, Tiodorovic Danica, Zalaudek Iris, Kittler Harald, Lallas Aimilios
Аннотация
INTRODUCTION: Melanoma of the lentigo maligna (LM) type is challenging. There is lack of consensus on the optimal diagnosis, treatment, and follow-up.
OBJECTIVES: To obtain general consensus on the diagnosis, treatment, and follow-up for LM.
METHODS: A modified Delphi method was used. The invited participants were either members of the International Dermoscopy Society, academic experts, or authors of published articles relating to skin cancer and melanoma. Participants were required to respond across three rounds using a 4-point Likert scale). Consensus was defined as >75% of participants agreeing/strongly agreeing or disagreeing/strongly disagreeing.
RESULTS: Of the 31 experts invited to participate in this Delphi study, 29 participants completed Round 1 (89.9% response rate), 25/31 completed Round 2 (77.5% response rate), and 25/31 completed Round 3 (77.5% response rate). Experts agreed that LM diagnosis should be based on a clinical and dermatoscopic approach (92%) followed by a biopsy. The most appropriate primary treatment of LM was deemed to be margin-controlled surgery (83.3%), although non-surgical modalities, especially imiquimod, were commonly used either as alternative off-label primary treatment in selected patients or as adjuvant therapy following surgery; 62% participants responded life-long clinical follow-up was needed for LM.
CONCLUSIONS: Clinical and histological diagnosis of LM is challenging and should be based on macroscopic, dermatoscopic, and RCM examination followed by a biopsy. Different treatment modalities and follow-up should be carefully discussed with the patient.
OBJECTIVES: To obtain general consensus on the diagnosis, treatment, and follow-up for LM.
METHODS: A modified Delphi method was used. The invited participants were either members of the International Dermoscopy Society, academic experts, or authors of published articles relating to skin cancer and melanoma. Participants were required to respond across three rounds using a 4-point Likert scale). Consensus was defined as >75% of participants agreeing/strongly agreeing or disagreeing/strongly disagreeing.
RESULTS: Of the 31 experts invited to participate in this Delphi study, 29 participants completed Round 1 (89.9% response rate), 25/31 completed Round 2 (77.5% response rate), and 25/31 completed Round 3 (77.5% response rate). Experts agreed that LM diagnosis should be based on a clinical and dermatoscopic approach (92%) followed by a biopsy. The most appropriate primary treatment of LM was deemed to be margin-controlled surgery (83.3%), although non-surgical modalities, especially imiquimod, were commonly used either as alternative off-label primary treatment in selected patients or as adjuvant therapy following surgery; 62% participants responded life-long clinical follow-up was needed for LM.
CONCLUSIONS: Clinical and histological diagnosis of LM is challenging and should be based on macroscopic, dermatoscopic, and RCM examination followed by a biopsy. Different treatment modalities and follow-up should be carefully discussed with the patient.