Le May Océane, Cinotti Elisa, Perrot Jean-Luc, Tognetti Linda, Chauvel Picard Julie
Department of Oral and Maxillofacial Surgery, University Hospital of Saint-Etienne, France.
Department of Dermatology, University Hospital of Saint-Etienne, France.
Dermatol Surg. 2025 Apr 1;51(4):360-364. doi: 10.1097/DSS.0000000000004508. Epub 2024 Dec 3.
Lentigo maligna (LM) and LM melanoma (LMM) present surgical challenges due to their poorly defined boundaries, making it difficult to determine precise peripheral margins. In addition, their preferential localization on the face increases the need to minimize the amount of tissue excised. Striking a balance between reducing the excision size and maintaining oncologic effectiveness is critical in managing LM/LMM. Reflectance Confocal Microscopy (RCM), a noninvasive imaging method that provides cellular-level visualization, could be an ideal tool to define the peripheral margins in the "spaghetti" surgical technique.
This study aimed to evaluate the long-term outcomes of using RCM combined with the "spaghetti" technique for LM/LMM excisions.
Seventy patients with LM/LMM on the face underwent RCM-guided margin definition followed by the "spaghetti" technique. The sample of patients was the same group of patients included in the authors' 2017 study. The authors subsequently evaluated the effectiveness of the authors' protocol via regular follow-up of the cohort.
A total of 59 LMs and 11 LMMs were included. The mean follow-up time was 6.3 years. The recurrence rate was 5.7%. The authors identified 4 recurrences: 3 of which occurred more than 5 years after the procedure. The recorded mortality was 20%, no deaths were attributed to LM/LMM. The mean margin from lesion to clearance was 2.7 mm.
If the authors cluster the 3 principal studies in terms of cohort and follow-up time for LM/LMM treated by Wide local Excision, the recurrence rate is from 5.3% to 5.9%, which is equivalent to the authors'. However, the mean margin excision from lesion is more than 2 times inferior in the authors' protocol (2.7 mm vs 6.7 mm). Therefore, the spaghetti technique with RCM margin identification seems to be an effective method for LM/LMM management.
恶性雀斑样痣（LM）和恶性雀斑样痣黑色素瘤（LMM）因其边界不清给手术带来挑战，难以确定精确的周边切缘。此外，它们好发于面部，这增加了尽量减少组织切除量的需求。在减少切除范围与维持肿瘤治疗效果之间取得平衡对于LM/LMM的治疗至关重要。反射共聚焦显微镜（RCM）是一种能提供细胞水平可视化的非侵入性成像方法，可能是在“意大利面条”手术技术中确定周边切缘的理想工具。
本研究旨在评估RCM联合“意大利面条”技术用于LM/LMM切除的长期效果。
70例面部患有LM/LMM的患者接受了RCM引导下的切缘界定，随后采用“意大利面条”技术。患者样本与作者2017年研究中的为同一组患者。作者随后通过对该队列的定期随访评估了方案的有效性。
共纳入59例LM和11例LMM。平均随访时间为6.3年。复发率为5.7%。作者确定了4例复发：其中3例在术后5年以上发生。记录的死亡率为20%，无死亡归因于LM/LMM。从病变到切缘清除的平均距离为2.7毫米。
如果作者按照队列和随访时间对采用广泛局部切除治疗的LM/LMM的3项主要研究进行聚类，复发率为5.3%至5.9%，与作者的研究相当。然而，在作者的方案中，从病变处的平均切缘切除量要低2倍多（2.7毫米对6.7毫米）。因此，采用RCM切缘识别的意大利面条技术似乎是治疗LM/LMM的有效方法。
