Surgical Margins

Was your previous primary Lentigo Maligna as well?  5mm margins is the current standard for melanoma in situ (regardless of type) so you are really covered.  I know one study was published that might suggest more margins, but that hasn't been accepted as the standard of care.  Lentigo Maligna has a higher LOCAL recurrence rate than other types of melanoma, so the key is to watch the area for any type of regrowth.  As for your lesion that is 3 years out, you're past the usual time of 2 years which is typically when most lesions recur.  Since you have the required margins for both your primaries, I probably wouldn't do anything more at this point except be very vigilant in watching the scar areas for regrowth.  LM tends to grow laterally before it invades into the skin so watching the scar doesn't really jeopardize things.   If I were in your situation, I definitely wouldn't do anything with the first primary at this point.  I probably wouldn't redo the WLE on the second primary either – but I would watch this one closely.  The LM margins are acceptable but only you can decide if you are comfortable where things stand.

Just for clarification, a lesion is typically characterized as Lentigo Maligna when it is in situ, and Lentigo Maligna Melanoma when it becomes invasive. 

Best wishes,
Janner

Was your previous primary Lentigo Maligna as well?  5mm margins is the current standard for melanoma in situ (regardless of type) so you are really covered.  I know one study was published that might suggest more margins, but that hasn't been accepted as the standard of care.  Lentigo Maligna has a higher LOCAL recurrence rate than other types of melanoma, so the key is to watch the area for any type of regrowth.  As for your lesion that is 3 years out, you're past the usual time of 2 years which is typically when most lesions recur.  Since you have the required margins for both your primaries, I probably wouldn't do anything more at this point except be very vigilant in watching the scar areas for regrowth.  LM tends to grow laterally before it invades into the skin so watching the scar doesn't really jeopardize things.   If I were in your situation, I definitely wouldn't do anything with the first primary at this point.  I probably wouldn't redo the WLE on the second primary either – but I would watch this one closely.  The LM margins are acceptable but only you can decide if you are comfortable where things stand.

Just for clarification, a lesion is typically characterized as Lentigo Maligna when it is in situ, and Lentigo Maligna Melanoma when it becomes invasive. 

Best wishes,
Janner

Was your previous primary Lentigo Maligna as well?  5mm margins is the current standard for melanoma in situ (regardless of type) so you are really covered.  I know one study was published that might suggest more margins, but that hasn't been accepted as the standard of care.  Lentigo Maligna has a higher LOCAL recurrence rate than other types of melanoma, so the key is to watch the area for any type of regrowth.  As for your lesion that is 3 years out, you're past the usual time of 2 years which is typically when most lesions recur.  Since you have the required margins for both your primaries, I probably wouldn't do anything more at this point except be very vigilant in watching the scar areas for regrowth.  LM tends to grow laterally before it invades into the skin so watching the scar doesn't really jeopardize things.   If I were in your situation, I definitely wouldn't do anything with the first primary at this point.  I probably wouldn't redo the WLE on the second primary either – but I would watch this one closely.  The LM margins are acceptable but only you can decide if you are comfortable where things stand.

Just for clarification, a lesion is typically characterized as Lentigo Maligna when it is in situ, and Lentigo Maligna Melanoma when it becomes invasive. 

Best wishes,
Janner