Management of Lentigo Maligna

To the Editor.— The article by Dr Kelly in the May 1992 issue of theArchiveswas a very interesting case report, suggesting that management of lentigo maligna by careful observation at 6- to 12-month intervals might not prevent evolution to life-threatening lentigo maligna melanoma. 1 It brought to mind a remarkable case that was reported 10 years ago, wherein 14 lesions of evolving lentigo maligna melanoma were resected from the left cheek of a woman in her 50s over a period of 9 years. 2 That patient presented for cosmetic surgery for a 3-mm pigmented lesion that was diagnosed histologically as lentigo maligna. Although margins were negative, a 12-mm lentigo maligna in the same region was resected 10 months later. In spite of constant surveillance, and surgery before any subsequent lesion attained 1 cm in diameter, four separate invasive melanomas developed, eventuating in a 7-mm amelanotic melanoma 9 years