Lentigo maligna (LM), or Hutchinson melanotic freckle, is postulated to be the in situ phase of LM melanoma. It typically appears as irregularly pigmented macules arising predominantly on the sun-exposed face of elderly white persons. Histologically, it is characterized by atypical melanocytes in the epidermis. These lesions often enlarge slowly in the horizontal direction, and a reported 30% to 50% of cases may eventually become invasive.1 Treatment recommendations usually involve surgical excision, including Mohs micrographic surgery. However, patients may present with large facial lesions that are not suitable for wide local excision because of the risk of poor functional or cosmetic outcome. Many of these patients will also have comorbidities that preclude radical surgery. Radiotherapy offers an effective alternative to surgery, with an excellent reported local control rate of up to 100% in some series.2 We describe the use of radiotherapy in a patient with a large LM on the cheek.
Huynh NT, Veness MJ. Radiotherapy for Lentigo Maligna. Arch Dermatol. 2002;138(7):981-982. doi:10.1001/archderm.138.7.979