LAUSR

Purpose of ReviewLentigo maligna (LM) is a form of melanoma in situ and represents a diagnostic and therapeutic challenge due to its poorly defined, irregular borders; propensity for subclinical extension; and location on the background of severely sun-damaged skin. Reflectance confocal microscopy (RCM) is a non-invasive optical imaging tool that allows clinicians to detect LM and assess margin status in vivo.Recent FindingsRCM is very accurate for diagnosing LM and guiding biopsies, with sensitivities ranging from 93 to 100% and specificities 71–82%. It has also been used pre-operatively to map lesions, intra-operatively for real-time evaluation of surgical margins, and post treatment to monitor for recurrence.SummaryThe advent of newer technologies, including RCM, has advanced our ability to better diagnose and manage LM. RCM offers clinicians the ability to guide biopsies, accurately detect subclinical disease, and readily map LM margins. Future research is aimed at using RCM to allow clinicians to better spare healthy tissue and to reduce disease recurrence without subjecting patients to the lost time, cost, and potential morbidity associated with multiple surgeries.