Lentigo maligna part II: Management - 19/11/25

Doi : 10.1016/j.jaad.2024.07.1534

Sameer Gupta, MD, MPhil ^a, Michael Shaughnessy, MD ^b, Sarem Rashid, BS ^c, Anna M. Stagner, MD ^d, Jessica Fewkes, MD ^a,^b, Ashfaq A. Marghoob, MD ^e, Hensin Tsao, MD, PhD ^b,^c,^⁎

^a Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts

^b Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts

^c Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts

^d Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts

^e Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York

^∗ Correspondence to: Hensin Tsao, MD, PhD, Massachusetts General Hospital, Edwards 211, 50 Blossom St, Boston, MA 02114. Massachusetts General Hospital Edwards 211 50 Blossom St Boston MA 02114

Abstract

Lentigo maligna arises on chronically-sun damaged skin and can have extensive subclinical spread, often in functionally and cosmetically challenging areas. This two-part continuing medical education series reviews lentigo maligna. Part I reviews epidemiology, risk factors, clinical presentation, diagnostic tools, biopsy technique, and histopathology of lentigo maligna. Part II reviews both surgical and nonsurgical treatment options. Surgical approaches – including conventional excision, Mohs micrographic surgery, and staged excision – remain first-line therapy to achieve cure. Some patients may be poor surgical candidates or elect for alternative treatments. Nonsurgical modalities, such as topical and radiation therapy, are also reviewed. Finally, surveillance recommendations are discussed.

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Key words : lentigo maligna, melanoma, nonsurgical management, radiation therapy, surgical management, surveillance, topical therapy

Abbreviations used : AAD, ALA, CCA, CSD, EADO, LM, LMM, MAL, MIS, MMS, NCCN, RCM, RT

Plan

	Funding sources: The Department of Defense (HT9425-24-1-0930 to H.T.), The Richard Allen Johnson, MD Endowed Chair in Dermatology (to H.T.), and the generous donors to the MGH on behalf of melanoma research.
	Patient consent: Written consent for the publication of recognizable patient photographs or other identifiable material was obtained by the authors and attested to at the time of article submission to the journal stating that all patients gave consent with the understanding that this information may be publicly available.
	IRB approval status: Exempt.
	Date of release: December 2025.
	Expiration date: December 2028.