Role of radiotherapy in the treatment of lentigo maligna and lentigo maligna melanoma—a systematic review
Bibliographic record
Abstract
Background: Radiotherapy is one of the non-surgical treatments for lentigo maligna (LM) and lentigo maligna melanoma (LMM). Several studies reported an array of radiation regimens. In this review, we aim to discuss the effectiveness of different radiation regimens in terms of the calculation of the biologically effective dose (BED) value compared to clinical outcomes. Methods: The literature search was from July 24, 2024 until August 11, 2024 through PubMed, Cochrane Library, and Scopus using the keywords “lentigo maligna”, “lentigo maligna melanoma”, “Hutchinson”, “radiotherapy”, “Grenz ray”, “X-ray”, and “radiation therapy”. Any studies that had confirmed the diagnosis of LM/LMM clinically or histopathologically and were written in English were included, except review articles, single case reports, editorials, letters, and book chapters. Quality assessment was accomplished by using the Newcastle-Ottawa Quality Assessment Scale (NOS). The BED value was divided into late and early depending on tissue response using the formula (BED) = n × d [1 + d/(α/β)]. LM was considered late-responding tissue due to low α/β ratio (0.6–2.5). We compared the BED value with specific clinical outcomes, including complete response rate (CRR), clinical regression, local recurrence, metastatic progression, and chronic skin toxicity. Results: Ten studies (988 patients) primarily from Europe and North America evaluated radiotherapy for LM/LMM, mostly in elderly females (mean age 71.9 years). X-rays (10–250 kV) were used with BED values ranging from 17–587 Gy (early-responding) and 28–1,584 Gy (late-responding). Higher BED values shortened regression time. CRR was >87% across all studies. Local recurrence rate (LRR) was 0–7% with 20–250 kV (BED 103–162 Gy3) and 3–31% with 10–20 kV (BED 433–920 Gy3). Metastasis was rare (0–2%). Cosmetic outcomes were good to excellent, though high BED was linked to chronic skin toxicities. Conclusions: Higher BED values with different energy of X-ray utilization were generally associated with better CRR, lower LRR, better control of metastasis, and promising cosmetic results, though careful consideration is required to minimize complications. However, limitations such as inconsistent and incomplete data might introduce bias and affect the credibility of these conclusions.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.020 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.006 | 0.007 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".