Topical imiquimod treatment of lentigo maligna: Clinical and histologic evaluation

doi:10.1016/j.jaad.2004.05.004

Journal of the American Academy of Dermatology

Volume 51, Issue 4, October 2004, Pages 635-639

https://doi.org/10.1016/j.jaad.2004.05.004 Get rights and content

We have treated extensive lentigo maligna in two elderly patients with Imiquimod 5% (Aldara). It was applied 3 times weekly, for 3 to 5 months. Clinical and histological remission was observed over 13 months of follow-up care. Tolerance was good. We suggest that topical imiquimod could be an interesting therapeutic alternative.

Section snippets

Case reports

An 80-year-old-woman presented with an extensive lentigo maligna of the face. It evolved over 20 years, and she had undergone 11 surgical procedures to treat the initial lentigo maligna and recurrences. The last intervention before presentation at our hospital was in 1999 when histopathological examination confirmed a transformation to melanoma with 0.3 mm of Breslow and Clark level II. In November 2000, the whole left cheek was pigmented including the lower eyelid, with some hypopigmented

Discussion

Imiquimod is an immune response-modifying drug that demonstrates potent antiviral and antitumor activity.¹ It is usually prescribed for the treatment of external genital and perianal warts.² It induces the release of pro-inflammatory cytokines in the skin by monocytes-macrophage.3., 4. It favours Th1 balance, production of natural killer cells, and cytotoxic T lymphocytes against viral agents and tumorr cells. Based on the hypothesis that topical imiquimod may promote an immune response against

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Cited by (36)

A quantitative systematic review of the efficacy of imiquimod monotherapy for lentigo maligna and an analysis of factors that affect tumor clearance
2015, Journal of the American Academy of Dermatology
Citation Excerpt :
The cases spanned from 2000 to 2014, with follow-up time ranging from 0 to 48.6 months. Of 347 included tumors, 110 came from case studies and 237 from cohort studies (including 42 from 1 arm of a randomized controlled trial).14-18,20-59 Ten studies (6 case studies and 4 cohorts) addressed both primary and recurrent tumors.27,30,31,38,42,46,52,57-59
The reported efficacy of imiquimod for lentigo maligna varies widely, without consensus on tumor or treatment factors that can impact tumor clearance.
We sought to provide a more precise estimate of clearance rates in patients with lentigo maligna who are treated with imiquimod and to analyze factors that can impact tumor clearance.
We performed a literature search for biopsy-proven lentigo maligna treated with imiquimod monotherapy, linked treatment and outcome data to individual tumors, calculated histologic and clinical clearance rates with 95% confidence intervals (CIs), and analyzed the impact of tumor and treatment factors on tumor clearance using logistic regression.
Based on 347 tumors from 45 studies, histologic and clinical clearance rates were 76.2% (95% CI, 71.4-81.0%) and 78.3% (95% CI, 73.6-82.9%), respectively. The incidence of clinical recurrence was 2.3% (95% CI, 0.5-4.2%), with a mean follow-up of 34.2 ± 11.8 months. Treatment with >60 total applications, or with >5 applications per week was associated with a higher likelihood of histologic clearance (odds ratio, 8.4 [95% CI, 2.9-24.1] and odds ratio, 6.0 [95% CI, 2.4-14.7], respectively).
Our limitations included the accuracy and scope of published data, variable follow-up times, potential patient selection, and publication bias related to case series/cohort designs of previous studies.
Imiquimod offers a 76% histologic and 78% clinical clearance rate for lentigo maligna. Both cumulative dose and treatment intensity affect tumor clearance.
Melanoma in situ: Part II. Histopathology, treatment, and clinical management
2015, Journal of the American Academy of Dermatology
Citation Excerpt :
Its use for MIS is considered off-label but has been described in the literature.56 Clearance rates with imiquimod vary widely, with some MIS lesions failing to respond at all and others clearing 100% with no evidence of recurrence.57-69 Treatment regimens also varied widely, with some using the medication several days a week and others using it only once weekly.
Melanoma in situ (MIS) poses special challenges with regard to histopathology, treatment, and clinical management. The negligible mortality and normal life expectancy associated with patients with MIS should guide treatment for this tumor. Similarly, the approach to treatment should take into account the potential for MIS to transform into invasive melanoma, which has a significant impact on morbidity and mortality. Part II of this continuing medical education article reviews the histologic features, treatment, and management of MIS.
Lentigo maligna
2013, Actas Dermo-Sifiliograficas
El lentigo maligno (LM) es una variante de melanoma in situ que se desarrolla principalmente en áreas de exposición solar crónica en pacientes de edad media-avanzada. Puede evolucionar a su forma invasiva lentigo maligno melanoma (LMM) en el 5-50% de los casos. Su manejo en ocasiones en controvertido, destacando la ausencia de estudios prospectivos aleatorizados y de guías específicas o protocolos. Es necesario realizar un diagnóstico y tratamiento precoces para obtener la curación, si es posible, y evitar la evolución a melanoma invasivo con el consiguiente riesgo metastásico. El tratamiento de elección del LM es la cirugía. Cuando esta no es posible pueden utilizarse otras alternativas con resultados y tasas de recidiva variables. El objetivo del presente trabajo es realizar una revisión de los métodos y criterios diagnósticos de LM, así como de las diferentes modalidades de tratamiento quirúrgico y las alternativas al mismo, que favorezca el mejor enfoque en cada caso.
Lentigo maligna is a type of in situ melanoma. It develops mainly in middle-aged and elderly individuals on areas of the skin chronically exposed to sunlight. It progresses to its invasive form, lentigo maligna melanoma, in 5% to 50% of cases. Management of lentigo maligna is open to debate, with a notable lack of randomized trials and specific guidelines and protocols. Early diagnosis and treatment is necessary to achieve cure if possible and prevent progression to invasive melanoma with the corresponding risk of metastasis. The treatment of choice for lentigo maligna is surgery. When surgery is not possible, other alternatives are available although outcomes and rates of recurrence are variable. The objective of this study was to review the diagnostic methods and criteria for lentigo maligna, as well as the different surgical options and alternatives to surgery, in order to provide information on the best approach in each case.
Lentigines, nevi, and melanomas
2009, Weedon's Skin Pathology: Third Edition
Managing Melanoma In Situ
2010, Seminars in Cutaneous Medicine and Surgery
Topical Treatment of Melanoma In Situ, Lentigo Maligna, and Lentigo Maligna Melanoma with Imiquimod Cream: A Systematic Review of the Literature
2023, Dermatology and Therapy

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Conflicts of interest: None identified.

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Brief ReportTopical imiquimod treatment of lentigo maligna: Clinical and histologic evaluation

Section snippets

Case reports

Discussion

J Invest Dermatol

J Am Acad Dermatol

J Am Acad Dermatol

J Am Acad Dermatol

J Am Acad Dermatol

J Am Acad Dermatol

Imiquimod: a potential role in dermatology?

Br J Dermatol

Management of anogenital warts (condylomata acuminata)

Eur J Dermatol

Brief Report
Topical imiquimod treatment of lentigo maligna: Clinical and histologic evaluation