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Spaghetti Technique Versus Wide Local Excision for Lentigo Maligna Affecting the Head and Neck Regions: Surgical Outcome and Descriptive Analysis of 79 Cases from a Single Practice Cohort

Publicated to:Dermatol Pract Concept. 13 (3): e2023193- - 2023-07-01 13(3), DOI: 10.5826/dpc.1303a193

Authors: Martinez-Molina, Manel; Richarz, Nina; Jaka, Ane; Bassas-Vila, Juli; Mora-Fernandez, Veronica; Pi-Sunyer, Ariadna Quer; Podlipnik, Sebastian; Carrascosa, Jose Manuel; Boada, Aram

Affiliations

Autonomous Univ Barcelona, Barcelona, Spain - Author
Hosp Badalona Germans Trias & Pujol, Dept Dermatol, Badalona, Spain - Author
Hosp Badalona Germans Trias & Pujol, Dept Pathol, Badalona, Barcelona, Spain - Author
Univ Barcelona, Hosp Clin Barcelona, Dept Dermatol, Melanoma Unit,IDIBAPS, Barcelona, Spain - Author

Abstract

Introduction: Lentigo maligna is a subtype of melanoma in situ that typically affects the head and neck region with an increasing incidence. Margin-controlled techniques, such as spaghetti technique (ST), have gained popularity over wide local excision (WLE) with a margin of 5 mm. Objectives: To evaluate the outcomes of lentigo maligna cases in the head and neck area treated by either WLE or ST in a tertiary referral hospital. The secondary goal was to describe the demographic and clinical characteristics of our series. Methods: Cohort study of patients diagnosed with lentigo maligna on the head and neck region between January 2014 and February 2022 in a tertiary hospital. Results: In total, 79 lentigo maligna were studied, corresponding to 77 patients. Fifty-three lesions (67%) were treated with WLE and 26 (33%) with ST. The mean age of the patients was 73 years and 58% were men. Most of the tumors were located on the cheek (50%) and mean lesion diameter was 2.2 cm for the ST group and 1.2 cm for the WLE group. Mean duration follow-up was 44 months. There were two local recurrences in the WLE group (2/53; 3.7%) and none in the ST group. Conclusions: Both WLE and ST are appropriate surgical approaches for lentigo maligna. ST offers an efficient alternative to Mohs surgery for treating lentigo maligna in the head and neck area, especially when guided by reflectance confocal microscopy.

Keywords
melanomaspaghetti techniquewide local excisionLentigo malignaMargin controlMelanomMelanomaMinnesotaMohs micrographic surgeryPermanent sectionsRecurrenceSpaghetti techniqueStaged excisionTimWide local excision

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Dermatol Pract Concept due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2023, it was in position 36/94, thus managing to position itself as a Q2 (Segundo Cuartil), in the category Dermatology. Notably, the journal is positioned en el Cuartil Q2 para la agencia Scopus (SJR) en la categoría Dermatology.

From a relative perspective, and based on the normalized impact indicator calculated from the Field Citation Ratio (FCR) of the Dimensions source, it yields a value of: 2.61, which indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: Dimensions May 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-05-23, the following number of citations:

  • WoS: 1
Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-05-23:

  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 11 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

    It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

    • The work has been submitted to a journal whose editorial policy allows open Open Access publication.
    • Additionally, the work has been submitted to a journal classified as Diamond in relation to this type of editorial policy.