. 2023 Jul 1;13(3):e2023244.

doi: 10.5826/dpc.1303a244.

Delphi Consensus Among International Experts on the Diagnosis, Management, and Surveillance for Lentigo Maligna

Caterina Longo^{1

2}, Cristian Navarrete-Dechent^{3

4}, Philipp Tschandl⁵, Zoe Apalla⁶, Giuseppe Argenziano⁷, Ralph P Braun⁸, Veronique Bataille⁹, Horacio Cabo¹⁰, Rainer Hoffmann-Wellhenhof¹¹, Ana Maria Forsea¹², Claus Garbe¹³, Pascale Guitera¹⁴, Karls Raimond¹⁵, Ashfaq A Marghoob¹⁶, Josep Malvehy¹⁷, Veronique Del Marmol¹⁸, David Moreno¹⁹, Kishwer S Nehal¹⁶, Eduardo Nagore²⁰, John Paoli²¹, Giovanni Pellacani²², Ketty Peris²³, Susana Puig¹⁷, H Peter Soyer²⁴, Susan Swetter²⁵, Alexander Stratigos²⁶, Wilhelm Stolz²⁷, Luc Thomas²⁸, Danica Tiodorovic²⁹, Iris Zalaudek³⁰, Harald Kittler⁵, Aimilios Lallas³¹

Affiliations

¹ Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.
² Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Skin Cancer Center, Reggio Emilia, Italy.
³ Department of Dermatology, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.
⁴ Melanoma and Skin Cancer Unit, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.
⁵ Department of Dermatology, Medical University of Vienna, Vienna, Austria.
⁶ Second Dermatology Department, Aristotle University of Thessaloniki, Greece.
⁷ Dermatology Unit, University of Campania, Naples.
⁸ Department of Dermatology, University Hospital of Zürich, University of Zürich, Zürich, Switzerland.
⁹ Dermatology, Mount Vernon Cancer Centre, Northwood, Middlesex, UK.
¹⁰ Dermatology Department "Instituto de Investigaciones Médicas A. Lanari", University of Buenos Aires, Argentina.
¹¹ Nonmelanoma Skin Cancer Unit, Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria.
¹² Dermatology Department, Elias University Hospital, Carol Davila University of Medicine and Pharmacy Bucharest, Romania.
¹³ Center for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tübingen, Germany.
¹⁴ Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, Australia.
¹⁵ Derma Clinic Riga, Riga, Latvia.
¹⁶ Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
¹⁷ Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, Spain.
¹⁸ Department of Dermatology, CUB Hôpital Erasme - Brussels University Clinics, Université Libre de Bruxelles, Brussels, Belgium.
¹⁹ Dermatology Unit, Hospital Universitario Virgen Macarena, Seville, Spain.
²⁰ Dermatology Department, Instituto Valenciano de Oncología, Valencia, Spain.
²¹ Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
²² Dermatology Clinic, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
²³ Institute of Dermatology, Università Cattolica-Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
²⁴ Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, QLD 4102, Australia.
²⁵ Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, California.
²⁶ Department of Dermatology-Venereology, Faculty of Medicine, National and Kapodistrian University of Athens, 'A. Sygros' Hospital for Skin and Venereal Diseases, Athens, Greece.
²⁷ Department of Dermatology, Allergology, and Environmental Medicine Clinic Thalkirchen, Hospital Munich, Munich, Germany.
²⁸ Department of Dermatology, Lyon-1 University, and Cancer research center Lyon, Lyon, France.
²⁹ Clinic of Dermatovenereology, Clinical Center of Nis, Serbia.
³⁰ Department of Dermatology and Venereology, Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy.
³¹ First Department of Dermatology, School of Medicine, Aristotle University, Thessaloniki, Greece.

PMID: 37403983
PMCID: PMC10412039
DOI: 10.5826/dpc.1303a244

Delphi Consensus Among International Experts on the Diagnosis, Management, and Surveillance for Lentigo Maligna

Caterina Longo et al. Dermatol Pract Concept. 2023.

. 2023 Jul 1;13(3):e2023244.

doi: 10.5826/dpc.1303a244.

Authors

Affiliations

¹ Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.
² Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Skin Cancer Center, Reggio Emilia, Italy.
³ Department of Dermatology, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.
⁴ Melanoma and Skin Cancer Unit, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.
⁵ Department of Dermatology, Medical University of Vienna, Vienna, Austria.
⁶ Second Dermatology Department, Aristotle University of Thessaloniki, Greece.
⁷ Dermatology Unit, University of Campania, Naples.
⁸ Department of Dermatology, University Hospital of Zürich, University of Zürich, Zürich, Switzerland.
⁹ Dermatology, Mount Vernon Cancer Centre, Northwood, Middlesex, UK.
¹⁰ Dermatology Department "Instituto de Investigaciones Médicas A. Lanari", University of Buenos Aires, Argentina.
¹¹ Nonmelanoma Skin Cancer Unit, Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria.
¹² Dermatology Department, Elias University Hospital, Carol Davila University of Medicine and Pharmacy Bucharest, Romania.
¹³ Center for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tübingen, Germany.
¹⁴ Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, Australia.
¹⁵ Derma Clinic Riga, Riga, Latvia.
¹⁶ Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
¹⁷ Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, Spain.
¹⁸ Department of Dermatology, CUB Hôpital Erasme - Brussels University Clinics, Université Libre de Bruxelles, Brussels, Belgium.
¹⁹ Dermatology Unit, Hospital Universitario Virgen Macarena, Seville, Spain.
²⁰ Dermatology Department, Instituto Valenciano de Oncología, Valencia, Spain.
²¹ Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
²² Dermatology Clinic, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
²³ Institute of Dermatology, Università Cattolica-Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
²⁴ Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, QLD 4102, Australia.
²⁵ Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, California.
²⁶ Department of Dermatology-Venereology, Faculty of Medicine, National and Kapodistrian University of Athens, 'A. Sygros' Hospital for Skin and Venereal Diseases, Athens, Greece.
²⁷ Department of Dermatology, Allergology, and Environmental Medicine Clinic Thalkirchen, Hospital Munich, Munich, Germany.
²⁸ Department of Dermatology, Lyon-1 University, and Cancer research center Lyon, Lyon, France.
²⁹ Clinic of Dermatovenereology, Clinical Center of Nis, Serbia.
³⁰ Department of Dermatology and Venereology, Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy.
³¹ First Department of Dermatology, School of Medicine, Aristotle University, Thessaloniki, Greece.

PMID: 37403983
PMCID: PMC10412039
DOI: 10.5826/dpc.1303a244

Abstract

Introduction: Melanoma of the lentigo maligna (LM) type is challenging. There is lack of consensus on the optimal diagnosis, treatment, and follow-up.

Objectives: To obtain general consensus on the diagnosis, treatment, and follow-up for LM.

Methods: A modified Delphi method was used. The invited participants were either members of the International Dermoscopy Society, academic experts, or authors of published articles relating to skin cancer and melanoma. Participants were required to respond across three rounds using a 4-point Likert scale). Consensus was defined as >75% of participants agreeing/strongly agreeing or disagreeing/strongly disagreeing.

Results: Of the 31 experts invited to participate in this Delphi study, 29 participants completed Round 1 (89.9% response rate), 25/31 completed Round 2 (77.5% response rate), and 25/31 completed Round 3 (77.5% response rate). Experts agreed that LM diagnosis should be based on a clinical and dermatoscopic approach (92%) followed by a biopsy. The most appropriate primary treatment of LM was deemed to be margin-controlled surgery (83.3%), although non-surgical modalities, especially imiquimod, were commonly used either as alternative off-label primary treatment in selected patients or as adjuvant therapy following surgery; 62% participants responded life-long clinical follow-up was needed for LM.

Conclusions: Clinical and histological diagnosis of LM is challenging and should be based on macroscopic, dermatoscopic, and RCM examination followed by a biopsy. Different treatment modalities and follow-up should be carefully discussed with the patient.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None.

Figures

**Figure 1**
The Delphi process in the Lentigo maligna Consensus of Experts.

**Figure 2**
Flow diagram illustrating the three survey rounds of the Delphi study.

See this image and copyright information in PMC

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Delphi Consensus Among International Experts on the Diagnosis, Management, and Surveillance for Lentigo Maligna

Affiliations

Delphi Consensus Among International Experts on the Diagnosis, Management, and Surveillance for Lentigo Maligna

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Abstract

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