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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).
Offer imiquimod for patients with lentigo maligna in whom both surgery and radiotherapy are inappropriate or undesirable.
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.
Perform ultra-soft X-ray/grenzrays therapy when surgical removal of lentigo maligna is not possible or refused.
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.
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Perform complete surgical removal of lentigo maligna with 5 to 10 mm clinical margins, when possible.
Consider perioperative reflectance confocal microscopy margin assessment, when available, to aid in identifying subclinical extension and help define surgical excision margins.