Treatment of Lentigo Maligna

To the Editor.—  A potentially valuable lesson can be gleaned from the experience of Kopf and coworkers¹ in the radiotherapy of lentigo maligna. One patient (case 14) in their series developed regional lymph node metastases from a lesion in which an incisional (punch) biopsy specimen showed only noninvasive lentigo maligna. This fact adds weight to the argument advanced by many that, when possible, complete but conservative excision of the lesion should be performed, not only to achieve accurate microstaging, but also to reduce the likelihood of recurrence, so commonly observed after ablative therapy. While the authors rightfully suggest that the primary tumor might have shown dermal invasion had multiple biopsy specimens been taken, they subsequently imply that the absence of clinically obvious papular or nodular components argues against such a possibility.In tracing the origin of this oftrepeated axiom that a melanotic freckle without palpable nodularity is likely benign