In vivo reflectance confocal microscopy to optimize the spaghetti technique for defining surgical margins of lentigo maligna.

Champin J, Perrot JL, Cinotti E, Labeille B, Douchet C, Parrau G, Cambazard F, Seguin P, Alix T.; Dermatol Surg. 2014 Mar;40(3):247-56. doi: 10.1111/dsu.12432


BACKGROUND: Lentigo maligna (LM) is a therapeutic challenge for surgeons because of its location in aesthetic areas and the difficultly in determining margins.


OBJECTIVE: To investigate a new procedure combining the "spaghetti" technique described by Gaudy-Marqueste and colleagues in 2011 with in vivo reflectance confocal microscopy (RCM) to define the margins of LM more accurately and allow strict histologic control.


METHODS AND MATERIALS: Thirty-three consecutive patients with LM of the head underwent a RCM-guided delineation of the margins followed by the "spaghetti" technique.


RESULTS: The excision of the first "spaghetti" in a tumor-free area was obtained in 28 of 33 patients. In the other five cases, persistence of LM foci was found in <5% of the length of spaghetti. The average number of pieces of "spaghetti" was 1.2 (range 1-3). Definitive histologic examination of the lesion showed a minimum average margin of 2.7 mm. Follow-up in 27 patients after an average of 10 months (range 4-25 months) did not show any recurrence.


CONCLUSION: This procedure allows accurate definition of the surgical margins of LM, with a low rate of multiple excisions, sparing tissue in functional and aesthetic areas. These results should be confirmed on the basis of a larger series with longer follow-up.