Background: The treatment of lentigo maligna (LM) can be challenging in older patients and in delicate facial areas. Previous studies have shown that LM in 10% of patients is upstaged to LM melanoma (LMM) after surgery.
Objectives: To identify, via a nationwide cohort study, the diagnostic modalities and available treatments for LM in the Netherlands, and to investigate the rates of postoperative upstaging to LMM and recurrence post-treatment.
Methods: To investigate the modalities used to diagnose LM and the rate of upstaging to LMM after surgery, data from 2020 were retrieved from the Dutch Nationwide Pathology Databank ('Palga'). To investigate the available treatments for LM, data were retrieved from the Netherlands Cancer Registry between 2013 and 2016. To investigate post-treatment recurrences, all reports of LM from 2013 to 2021 were retrieved from Palga.
Results: In 2020, 1422 patients in the Netherlands were diagnosed with primary LM. Diagnoses were made using a punch biopsy in 60.8% of cases (n = 864) and with an excisional biopsy in 37.1% (n = 527). Half of the patients (n = 713; 50.1%) were treated surgically and 14.2% (n = 101/713) were upstaged to LMM/melanoma after surgery. Between 2013 and 2016, wide local excision (WLE) was performed in 79.7% (n = 2860/3587) of cases of histopathologically confirmed primary LM, staged excision was chosen in 1.6% (n = 58), watchful waiting in 1.5% (n = 55) and noninvasive treatments in 4.5% (n = 162). With a median follow-up until death or censoring at 5.7 years, there were 247 (6.9%) recurrences, with a median time to recurrence of 2.4 years.
Conclusions: In the Netherlands, patients with LM are most often diagnosed with a punch biopsy and most are treated with WLE, in line with Dutch melanoma guidelines. Using a nationwide database, 14% of histologically proven cases of LM were upstaged to LMM postsurgery. This should be considered when choosing treatment, especially when considering nonsurgical treatments. The significant number of recurrences in patients who received nonsurgical treatment demonstrates the complexity of treating LM and the importance of balancing histological clearance with sometimes disfiguring surgery in the head-and-neck region.
Lentigo maligna is the most common type of the earliest stage of a skin cancer called melanoma. It generally affects older people and is often found in the head and neck area. If it is not treated properly, it can develop into an invasive melanoma. In this study, researchers from the Netherlands used information collected in two Dutch databases. We analysed the information to find out how lentigo maligna is diagnosed. We also wanted to find out how many patients actually have an invasive melanoma after surgery. Finally, we gathered information on how lentigo maligna is treated and if it comes back after treatment. Most people are diagnosed with a biopsy and treated with surgery. We also found that 14% of patients actually have an invasive melanoma after their surgery. Of more than 3,500 patients included in the study, lentigo maligna came back in almost 250 after they were treated, which is about 7% of patients. Our findings show how difficult lentigo maligna is to treat. There is a wide range of treatment options and it comes back in a lot of patients after they are treated. Some people actually have an invasive melanoma after their surgery. Unfortunately, surgery for lentigo maligna can be disfiguring, so it is important that doctors help patients to make informed treatment choices.
© The Author(s) 2026. Published by Oxford University Press on behalf of British Association of Dermatologists.