Meijer, Dylan Edmond Tjerk (2025) Achieving Tumor-Free Margins in Lentigo Maligna: A Clinical Evaluation of the Micrographic Breuninger Technique in Two Top Clinical Dutch Hospitals in Twente. thesis, Medicine.
Full text available on request.Abstract
Introduction and background Lentigo maligna (LM) is a precursor to lentigo maligna melanoma (LMM), predominantly affecting sun-damaged skin in elderly individuals, particularly on the face. The clinical borders of LM are often ill-defined, and the lesion may extend subclinically. This irregular growth pattern makes complete surgical excision particularly challenging. As a result, conventional excision techniques are associated with a high risk of incomplete removal and subsequent recurrence, marking the interest in different excision methods. The Breuninger Micrographic Technique (BMT), a staged excision method with comprehensive margin control, has increasingly been proposed as a promising treatment strategy for LM. This technique enables the precise and stepwise removal of tumor tissue, accompanied by thorough histological assessment of the peripheral margins a critical advantage given LM’s characteristic subclinical spread. This retrospective study evaluates the effectiveness of BMT in patients diagnosed with LM and treated at two Dutch top-clinical hospitals; Medisch Spectrum Twente (MST) and Ziekenhuis Groep Twente (ZGT). The primary aim is to determine the proportion of patients with subclinical invasion, and to identify clinicopathological factors that may predict invasive growth. Aim This study aims to evaluate the effectiveness of the BMT in patients with LM by determining the proportion of patients who achieve tumor-free margins after the first excision round, assessing the prevalence of subclinical invasion, and identifying clinicopathological factors associated with invasive growth and the need for multiple surgical stages. The findings may contribute to the future optimization of treatment guidelines for LM. Methods A retrospective descriptive epidemiological study was conducted on 40 patients diagnosed with LM and treated with BMT at the two hospitals between September 2022 and November 2024. Patient demographics, lesion characteristics, and surgical outcomes were extracted from anonymized electronic medical records. Statistical analyses included descriptive statistics, t-tests, chi-square tests, and logistic regression modeling. 4 Results Tumor-free margins were achieved in 42.5% of patients after the first round of BMT. The mean age of the patients was 75.9 years (range 63–90), which aligns with the typical prevalence of LM in older adults (1). Larger lesions and the presence of invasive growth were associated with the need for additional excision stages. No statistically significant associations were found with gender or a history of skin malignancies. The average number of surgical rounds was 1.78. Conclusion BMT is an effective surgical approach for managing LM, particularly in cosmetically sensitive areas. While most cases required more than one stage, the technique provides precise margin control, potentially reducing recurrence risk. Further research with larger sample sizes and long-term follow-up is recommended. Keywords: Lentigo maligna, Breuninger micrographic surgery, melanoma in situ, margin control, surgical outcomes, invasive growth, recurrence.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Vogel, Dr. T. and Theunissen, Drs. C. and Ruiter, Drs. L. De |
| Faculty: | Medical Sciences |
| Date Deposited: | 10 Apr 2026 13:41 |
| Last Modified: | 10 Apr 2026 13:41 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3919 |
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