Lentigo maligna of the scalp treated with radiation therapy

(A) A 62-year-old with a large area of biopsy-proven lentigo maligna on the scalp. The area was defined by reflective confocal microscopy. The treatment option of surgical excision with a skin graft repair, radiotherapy, and imiquimod was discussed with him. He was randomized to RT in a clinical trial. The area was treated to 56 Gy in 28 fractions.
(B) The appearance 6 months after completion of RT. On reflective confocal microscopy, there were few scattered dendritic cells but no evidence of residual lentigo maligna.