A LARGE nationwide study from the Netherlands has provided new insight into how lentigo maligna (LM) is diagnosed and treated in routine clinical practice, revealing substantial rates of tumour upstaging and recurrence that may influence management decisions, particularly in older patients and those with lesions in cosmetically sensitive areas.
Treatment Approaches for Lentigo Maligna in the Netherlands
LM is a melanoma in situ that commonly affects sun-exposed skin of the head and neck. Treatment can be challenging due to patient age, comorbidities, and the potential morbidity of surgery. While surgical excision is considered the standard of care, non-surgical approaches are sometimes used, despite uncertainty around long-term outcomes.
Using data from multiple national registries, researchers analysed diagnostic methods, treatment strategies, rates of upstaging to lentigo maligna melanoma (LMM), and recurrence patterns. Diagnostic data from 2020 were obtained from the Dutch Nationwide Pathology Databank (Palga), while treatment data were retrieved from the Netherlands Cancer Registry between 2013 and 2016. Recurrence outcomes were assessed using pathology reports from 2013 to 2021.
In 2020, 1,422 patients were diagnosed with primary LM in the Netherlands. Punch biopsy was the most frequently used diagnostic modality, accounting for 61% of cases, followed by excisional biopsy in 37%. Half of all patients underwent surgical treatment, among whom 14% were upstaged to LMM or invasive melanoma following surgery.
Treatment pattern analysis showed that wide local excision was used in 80% of 3,587 histologically confirmed LM cases. Staged excision was performed in only 2% of patients, while watchful waiting and non-invasive treatments were used in 1.5% and 4.6% of cases, respectively.
Recurrence Rates Following Lentigo Maligna Treatment
With a median follow-up of 5.7 years, 247 recurrences were identified, corresponding to an overall recurrence rate of 6.9%. The median time to recurrence was 2.4 years, highlighting the need for prolonged surveillance following treatment.
The authors conclude that current practice in the Netherlands largely aligns with national melanoma guidelines. However, the notable rate of upstaging after surgery and the occurrence of recurrences, particularly following non-surgical treatments, underscore the complexity of managing LM. These findings emphasise the importance of carefully balancing histological clearance against the functional and cosmetic consequences of surgery in the head and neck region.
Reference
Zoutendijk J et al. A nationwide study of treatment and recurrence rate of lentigo maligna in the Netherlands. Br J Dermatol. 2026;doi10.1093/bjd/ljag011.
