Guideline sources The following summarized guidelines for the management of lentigo maligna are prepared by our editorial team based on guidelines from the Cancer Council Australia (CCA 2019). 1 Guidelines 1. Medical management Medical therapy: Offer imiquimod for patients with lentigo maligna in whom both surgery and radiotherapy are inappropriate or undesirable. B Consider tazarotene as an adjuvant therapy to imiquimod, as it can increase the inflammatory response when used in patients with lentigo maligna, recognizing that it is unknown whether this translates into improved treatment efficacy. C 2. Therapeutic procedures Radiotherapy: Perform ultra-soft X-ray/grenzrays therapy when surgical removal of lentigo maligna is not possible or refused. B Consider ultra-soft X-ray/grenzrays therapy as an alternative to surgical excision or as an adjuvant therapy after surgical excision, especially for patients with large lesions. C https://web.pathway.md/diseases/recyEAJa5GxcevRkr 1/2 6/29/23, 5:52 AM Lentigo maligna Pathway Laser therapy: do not use laser therapy for the treatment of patients with lentigo maligna. D Cryotherapy: do not use cryotherapy for the treatment of patients with lentigo maligna. D 3. Surgical interventions Surgery: Perform complete surgical removal of lentigo maligna with 5 to 10 mm clinical margins, when possible. B Consider perioperative reflectance confocal microscopy margin assessment, when available, to aid in identifying subclinical extension and help define surgical excision margins. C References 1. Robinson M, Primiero C, Guitera P et al. Evidence-Based Clinical Practice Guidelines for the Management of Patients with Lentigo Maligna. Dermatology. 2019 Oct 22 1 6. Open https://web.pathway.md/diseases/recyEAJa5GxcevRkr 2/2