Case of large lentigo maligna melanoma of the scalp treated with 5% and 3.75% Imiquimod

Abstract

The paper presents a case of lentigo maligna melanoma of the scalp in an elderly patient treated for the nodular part with surgery and the residual melanoma in situ with 5% Imiquimod and subsequently with 3.75% Imiquimod (each concentration for 4 months, 5 times per week), with complete regression of the lesion. 3.75% Imiquimod, which is already used for the treatment of actinic keratosis, could be a useful weapon with the same effectiveness and fewer side effects compared to 5% Imiquimod.

Topical Treatment of Melanoma In Situ, Lentigo Maligna, and Lentigo Maligna Melanoma with Imiquimod Cream: A Systematic Review of the Literature

“…[ 114 ] (2021) CR 1 2 66 MIS: upper limb H 1/5 packet of imiquimod 5% cream, one drop of 5-fluorouracil 2% solution, and 1/5 of a pea-sized quantity of tretinoin 0.1% cream with a bandage overnight (30 applications within a 42-day period) He completed his treatment protocols over 30 days NR Complete (C) NR NR Rovesti et al . [ 115 ] (2021) CR 1 1 90 LM: scalp H Imiquimod 5% once/d 5 t/w for 4 m, then Imiquimod 3.75% once/d 5 t/w for 4 m NR Complete (C) NR NR Misiak-Galazka et al [ 116 ] (2022) CR 1 1 82 LM: cheek H Imiquimod 5% once/d 5 t/w for 5 w, 3 cycles 1–2 Complete (C) 24 m 0 (C) Poveda-Montoyo et al . [ 117 ] (2022) CS 13 14 48–84 μ = 69.5 LM and LMM: nose (6), cheek (4), temple (2), back (1), upper lip (1) H (1) Monotherapy Imiquimod 5% once/d 7 t/w for 5–11 w ± tazarotene gel 0.05% (2) Neoadjuvant Imiquimod 5% once/d 7 t/w for 5–11 w ± tazarotene gel 0.05% + narrow excision 1 Complete (C) μ = 66.4 m 2 (C) Soenen et al .…”

Treatment and follow-up of melanoma in situ in a geriatric patient that is a nonsurgical candidate

“…4 Although topical 5% imiquimod treatment has been shown to be effective in melanoma in situ, no standard treatment regimen exists. 3,14 Frequency of application, length of treatment, treatment margins, and occlusion versus without occlusion vary. 8 Evidence has shown inflammation is essential for the treatment's efficacy.…”

“…5,8,15 Some studies discuss the use of imiquimod as monotherapy, and others discuss combination therapy with tazarotene or 5-fluorouracil and tretinion. 4,8,10,14,15 In addition to post-treatment biopsies, this case study used PLA (DermTech, La Jolla, CA) to follow the patient posttreatment. This is a class I device that uses an adhesive patch sample collection platform to obtain epidermal RNA.…”

“…Evidence has shown inflammation is essential for the treatment’s efficacy 5,8,15 . Some studies discuss the use of imiquimod as monotherapy, and others discuss combination therapy with tazarotene or 5-fluorouracil and tretinion 4,8,10,14,15 …”

Use of Imiquimod 5% cream for the treatment of lentigo maligna on the face

“…Alternatively, topical treatment with imiquimod 5% cream (total of 60 applications) was performed (Figure 2a,b). 7,8 After the treatment no atypical cells were observed by RCM (Vivascope 3000) (Figure 2c) neither histological residual sign of melanocytic atypia (Figure 2d). The patient is under observation every 3 months with total body skin check and RCM of the area without any sign of recurrent disease for 24 months.…”