“This is probably one of the worst cutaneous tumors that we, as dermatologists, can see. It's right up there with a bad angiosarcoma,” he said.
Local recurrences are seen in 25%-33% of cases, regional spread in 25%, and distant metastasis in 33% of cases—50% by some reports—with a 3-year overall survival of 31%.
Treatment is controversial, noted Dr. Brown.
Wide local excision down to the fascia or Mohs surgery with sentinel lymph node biopsy is recommended, guiding the need for total lymph node dissection, postoperative radiation therapy, and perhaps even adjuvant chemotherapy, he said, adding that a negative sentinel lymph node carries a fairly reassuring prognosis.
'It's not at all unusual for me to see patients … in their 40s or 50s with their first lentigo maligna.' DR. BROWN