Recommendation ID

Surgical excision for people with lentigo maligna:- For people with lentigo maligna (stage 0 in sun-damaged skin, usually on the face) how effective is Mohs micrographic surgery, compared with excision with a 0.5 cm clinical margin, in preventing biopsy-proven local recurrence at 5 years?
This should be investigated in a randomised controlled trial. Secondary outcomes should include cosmetic and functional outcomes.

Any explanatory notes
(if applicable)

Why this is important:- Mohs micrographic surgery is a microscopically controlled surgical technique designed to allow complete excision of the tumour with minimal tissue loss. The technique can be useful for people with lentigo maligna because their lesions can be very large and located in a cosmetically sensitive site where surgery may cause significant scarring. However, the histological detection of small numbers of melanocytes at the edge of a sample is difficult, and can lead to false negative results. In addition, lentigo maligna may occur in an area of field change with a risk of skip lesions at the edge. Therefore, although Mohs micrographic surgery may ensure complete excision of lentigo maligna, it can be accompanied by the recurrence of a similar lesion in adjacent skin.

Source guidance details

Comes from guidance
Melanoma: assessment and management
Date issued
July 2015

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No