Department of Maxillofacial and Plastic Surgery, University Hospital of Saint Étienne, Saint-Étienne, France; Faculty of Medicine, University of Saint-Étienne, Saint-Étienne, France.
Dermatol Surg. 2014 Mar;40(3):247-56. doi: 10.1111/dsu.12432. Epub 2014 Jan 21.
Lentigo maligna (LM) is a therapeutic challenge for surgeons because of its location in aesthetic areas and the difficulty in determining margins.
To investigate a new procedure combining the "spaghetti" technique described by Gaudy-Marqueste and colleagues in 2011 with in vivo reflectance confocal microscopy (RCM) to define the margins of LM more accurately and allow strict histologic control.
Thirty-three consecutive patients with LM of the head underwent a RCM-guided delineation of the margins followed by the "spaghetti" technique.
The excision of the first "spaghetti" in a tumor-free area was obtained in 28 of 33 patients. In the other five cases, persistence of LM foci was found in <5% of the length of spaghetti. The average number of pieces of "spaghetti" was 1.2 (range 1-3). Definitive histologic examination of the lesion showed a minimum average margin of 2.7 mm. Follow-up in 27 patients after an average of 10 months (range 4-25 months) did not show any recurrence.
This procedure allows accurate definition of the surgical margins of LM, with a low rate of multiple excisions, sparing tissue in functional and aesthetic areas. These results should be confirmed on the basis of a larger series with longer follow-up.
由于位置在美学区域以及确定边界的困难，恶性雀斑样痣（LM）对外科医生来说是一个治疗挑战。
研究一种新的程序，将 Gaudy-Marqueste 等人在 2011 年描述的“意大利面条”技术与体内反射共聚焦显微镜（RCM）相结合，以更准确地定义 LM 的边界，并允许进行严格的组织学控制。
33 例头部 LM 连续患者接受 RCM 引导的边界划定，然后采用“意大利面条”技术。
在 33 例患者中，有 28 例在无肿瘤区域获得了第一个“意大利面条”的切除。在其他 5 例中，在“意大利面条”的长度的<5%中发现了 LM 灶的持续存在。“意大利面条”的平均数量为 1.2 个（范围 1-3）。对病变的明确组织学检查显示平均最小边界为 2.7 毫米。27 例患者在平均 10 个月（范围 4-25 个月）的随访中未发现任何复发。
该程序允许准确定义 LM 的手术边界，并且多次切除的发生率低，在功能和美学区域保留组织。这些结果应在更大的系列和更长的随访基础上得到证实。
