Patel A N, Perkins W, Leach I H, Varma S
Department of Dermatology, Queen's Medical Centre, Nottingham, UK.
Clin Exp Dermatol. 2014 Jul;39(5):570-6. doi: 10.1111/ced.12363.
Lentigo maligna (LM) and lentigo maligna melanoma (LMM) can be difficult to manage surgically. Predetermined margins can be inadequate because of subclinical spread, or can affect function when margins are adjacent to the eye or mouth.
To describe our 5-year experience in Nottingham of using the staged square procedure (Johnson square) in excising difficult facial LM and LMM.
The square procedure is a staged technique useful for ill-defined lesions and for lesions that have a high recurrence rate due to subclinical spread. It uses paraffin wax-embedded peripheral vertical sections for margin control, ensuring complete clearance as the surgical margins are usually examined at distances of 2-5 mm from the periphery of the lesion.
We treated 21 patients with LM or LMM with the staged square procedure over a 5-year period. Of the 21 patients, 10 needed only one stage of surgery, 6 needed two stages, 3 needed three stages and 2 needed four stages. To date, there has been only one recurrence, which was of an extensive lesion that crossed the medial canthus, making margin control impossible because of the anatomical limitations.
The staged square procedure is an effective treatment for LM and LMM. It attempts to conserve tissue while ensuring a higher clearance rate. This offers favourable cosmetic outcomes and better prognosis, especially for facial LM and LMM.
恶性雀斑样痣（LM）和恶性雀斑样痣黑色素瘤（LMM）的手术治疗可能具有挑战性。由于存在亚临床扩散，预定的切缘可能不足，或者当切缘靠近眼睛或嘴巴时可能会影响功能。
描述我们在诺丁汉使用分期方形手术（约翰逊方形手术）切除面部困难型LM和LMM的5年经验。
方形手术是一种分期技术，适用于边界不清的病变以及因亚临床扩散而复发率高的病变。它使用石蜡包埋的周边垂直切片进行切缘控制，确保完全切除，因为手术切缘通常在距病变周边2 - 5毫米处进行检查。
在5年期间，我们使用分期方形手术治疗了21例LM或LMM患者。在这21例患者中，10例仅需进行一期手术，6例需要两期，3例需要三期，2例需要四期。迄今为止，仅出现1例复发，是1例广泛病变，越过内眦，由于解剖学限制无法进行切缘控制。
分期方形手术是治疗LM和LMM的有效方法。它试图在确保更高切除率的同时保留组织。这提供了良好的美容效果和更好的预后，尤其是对面部LM和LMM而言。
