International Dermoscopy Society consensus recommendations for the management of lentigo maligna
Abstract
Lentigo maligna (LM) is a subtype of cutaneous melanoma in situ that develops on chronically sun-damaged skin in elderly individuals. Its diagnosis and management remain challenging due to its slow progression, frequent occurrence on cosmetically sensitive areas in frail individuals, and tendency for subclinical peripheral extension. Despite its potential for invasive transformation, the natural history of LM remains incompletely understood and evidence-based management strategies for this specific entity remain limited. This work aims to bridge the gap between scarce high-quality evidence and the clinicians' need for practical guidance on LM management by formulating evidence-based and expert consensus-driven recommendations for diagnosis, treatment and follow-up. Under the coordination of the International Dermoscopy Society, a global, multidisciplinary consortium of 53 experts-including dermatologists, dermato-oncologists, dermatologic surgeons, radiologists, radiotherapists, pathologists and epidemiologists-formulated recommendations through structured consensus, informed by a comprehensive review of current scientific evidence and clinical practice standards. Optimal management of LM requires accurate diagnosis and individualized treatment planning. Non-invasive skin imaging techniques, especially dermoscopy and reflectance confocal microscopy, aid in diagnosis, biopsy orientation, lesion delineation and post-treatment monitoring. Multiple partial biopsies help confirm diagnosis and rule out invasion. Complete surgical excision remains the first treatment option. No definitive safety margins can be recommended for standard surgery; margin-controlled techniques are preferable for large or ill-defined lesions. Topical imiquimod and radiotherapy are effective alternatives where surgery is unsuitable. Topical imiquimod is useful as primary, adjuvant or neoadjuvant therapy. Blind destructive methods should be avoided. Close clinical and imaging follow-up is needed. Patient-centred care, shared decision-making, and a multidisciplinary approach are critical for optimal outcomes. These international consensus recommendations summarize current best practices for LM management, offering practical, evidence-informed guidance to clinicians while acknowledging the potential of future research in refining these conclusions.
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BibTeX
@article{forsea2026international,
title = {{International Dermoscopy Society consensus recommendations for the management of lentigo maligna}},
author = {Ana‐maria Forsea and Riccardo Pampena and Bengu Nisa Akay and Zoe Apalla and Giuseppe Argenziano and Giulia Briatico and Ralph Braun and Horacio Cabo and Raul Cabrera and Cristina Carrera and Elisa Cinotti and Claudio Conforti and Enzo Errichetti and Gerardo Ferrara and Roberta Giuffrida and Stefania Guida and Pascale Guitera and Allan C. Halpern and Stephen Heyes and Rainer Hofmann‐wellenhof and Angela M. Hong and Natalia Jaimes and Raimonds Karls and Harald Kittler and Teresa Kränke and Konstantinos Liopyris and Jie Liu and Caterina Longo and Josep Malvehy and Ashfaq A. Marghoob and Hoda Moneib and David Moreno Ramirez and Elvira Moscarella and Eduardo Nagore and Cristian Navarrete‐dechent and John Paoli and Giovanni Pellacani and Ketty Peris and Susana Puig and Cliff Rosendahl and Lidia Rudnicka and Ahmed Sadek and Philippe Saiag and Gabriel Salerni and Alon Scope and Hans Peter Soyer and Michela V. Starace and Wilhelm Stolz and David L. Swanson and Luc Thomas and Philipp Tschandl and Iris Zalaudek and Aimilios Lallas},
journal = {Journal of the European Academy of Dermatology and Venereology},
year = {2026},
month = nov,
doi = {10.1111/jdv.70406},
url = {https://hal.science/hal-05851599v1},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - International Dermoscopy Society consensus recommendations for the management of lentigo maligna
AU - Ana‐maria Forsea
AU - Riccardo Pampena
AU - Bengu Nisa Akay
AU - Zoe Apalla
AU - Giuseppe Argenziano
AU - Giulia Briatico
AU - Ralph Braun
AU - Horacio Cabo
AU - Raul Cabrera
AU - Cristina Carrera
AU - Elisa Cinotti
AU - Claudio Conforti
AU - Enzo Errichetti
AU - Gerardo Ferrara
AU - Roberta Giuffrida
AU - Stefania Guida
AU - Pascale Guitera
AU - Allan C. Halpern
AU - Stephen Heyes
AU - Rainer Hofmann‐wellenhof
AU - Angela M. Hong
AU - Natalia Jaimes
AU - Raimonds Karls
AU - Harald Kittler
AU - Teresa Kränke
AU - Konstantinos Liopyris
AU - Jie Liu
AU - Caterina Longo
AU - Josep Malvehy
AU - Ashfaq A. Marghoob
AU - Hoda Moneib
AU - David Moreno Ramirez
AU - Elvira Moscarella
AU - Eduardo Nagore
AU - Cristian Navarrete‐dechent
AU - John Paoli
AU - Giovanni Pellacani
AU - Ketty Peris
AU - Susana Puig
AU - Cliff Rosendahl
AU - Lidia Rudnicka
AU - Ahmed Sadek
AU - Philippe Saiag
AU - Gabriel Salerni
AU - Alon Scope
AU - Hans Peter Soyer
AU - Michela V. Starace
AU - Wilhelm Stolz
AU - David L. Swanson
AU - Luc Thomas
AU - Philipp Tschandl
AU - Iris Zalaudek
AU - Aimilios Lallas
PY - 2026
DA - 2026/11/04
JO - Journal of the European Academy of Dermatology and Venereology
DO - 10.1111/jdv.70406
UR - https://hal.science/hal-05851599v1
AB - Lentigo maligna (LM) is a subtype of cutaneous melanoma in situ that develops on chronically sun-damaged skin in elderly individuals. Its diagnosis and management remain challenging due to its slow progression, frequent occurrence on cosmetically sensitive areas in frail individuals, and tendency for subclinical peripheral extension. Despite its potential for invasive transformation, the natural history of LM remains incompletely understood and evidence-based management strategies for this specific entity remain limited. This work aims to bridge the gap between scarce high-quality evidence and the clinicians' need for practical guidance on LM management by formulating evidence-based and expert consensus-driven recommendations for diagnosis, treatment and follow-up. Under the coordination of the International Dermoscopy Society, a global, multidisciplinary consortium of 53 experts-including dermatologists, dermato-oncologists, dermatologic surgeons, radiologists, radiotherapists, pathologists and epidemiologists-formulated recommendations through structured consensus, informed by a comprehensive review of current scientific evidence and clinical practice standards. Optimal management of LM requires accurate diagnosis and individualized treatment planning. Non-invasive skin imaging techniques, especially dermoscopy and reflectance confocal microscopy, aid in diagnosis, biopsy orientation, lesion delineation and post-treatment monitoring. Multiple partial biopsies help confirm diagnosis and rule out invasion. Complete surgical excision remains the first treatment option. No definitive safety margins can be recommended for standard surgery; margin-controlled techniques are preferable for large or ill-defined lesions. Topical imiquimod and radiotherapy are effective alternatives where surgery is unsuitable. Topical imiquimod is useful as primary, adjuvant or neoadjuvant therapy. Blind destructive methods should be avoided. Close clinical and imaging follow-up is needed. Patient-centred care, shared decision-making, and a multidisciplinary approach are critical for optimal outcomes. These international consensus recommendations summarize current best practices for LM management, offering practical, evidence-informed guidance to clinicians while acknowledging the potential of future research in refining these conclusions.
SN - 0926-9959
SN - 1468-3083
ER -