Lentigo Maligna presents a difficult problem for both the histopathologist and the plastic surgeon. The pathologist has great difficulty in assessing where the borders of the lesion lie, while the plastic surgeon is dealing with these lesions which commonly occur on the face, so an accurate border can ease the plan of reconstruction, while an inaccurate border can result in inadequate excision and recurrence. This is a very important paper, since it recommends ‘moving the goalposts’ for pathological assessment. Instead of the histopathologists being asked to guess where the lesion ends, the ‘tumour burden’ is assessed by counting the number of melanocytes present in one high power (X400) microscopic field at the border in question. Using this technique on historical cases in a blinded trial, 0.6% of cases were misdiagnosed, whereas by traditional assessment the comparison was 21% misdiagnosed. Clearly the authors of this paper have set an example which every plastic surgeon should adopt, or face the consequences of misdiagnosis and costly lawsuits.

A model for lentigo maligna recurrence using melanocyte count as a predictive marker based upon logistic regression analysis of a blinded retrospective review.
Gorman M, Khan MAA, Johnson PCD,  et al.
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