Original articleA quantitative systematic review of the efficacy of imiquimod monotherapy for lentigo maligna and an analysis of factors that affect tumor clearance
Section snippets
Data collection
PubMed search parameters were restricted to studies published in English between 2000 and 2014 containing the following terms: “Aldara,” “imiquimod,” “lentigo maligna,” and “melanoma in situ.” These studies were independently reviewed by Ms Mora and Dr Nguyen. Differences in study interpretation were discussed among all 3 authors to reach a consensus. All included cases were treated with imiquimod 5% cream. Tumors were excluded if (1) the diagnosis of LM was equivocal (ie, there was discordance
Results
Our PubMed search yielded 85 studies, of which 45 met the inclusion criteria (Table I). The most common reason for exclusion was the use of combination therapy of imiquimod with topical tazarotene, laser, or cryotherapy. Some tumors in original studies were not included in the final analysis because of the use of combination therapy (1),40 because they had been previously published (1),26 because they had a diagnosis other than LM (1),44 or because there were dropouts (2).18, 55 The cases
Discussion
Imiquimod offers reasonable histologic and clinical clearance rates for both primary and recurrent/previously treated LM, with a cumulative dose of >60 applications and treatment intensity of >5 applications per week predicting a higher likelihood of tumor clearance. Based on tumor-level analysis of 347 tumors from 45 published studies, the clinical and histologic clearance rates were 78.3% (95% CI, 73.6-82.9%) and 76.2% (95% CI, 71.4-81.0%), respectively. Treatment protocols varied
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Funding sources: None.
Conflicts of interest: None declared.