Change in lentigo maligna score assessed by in vivo reflectance confocal microscopy after 1 month of imiquimod treatment for lentigo maligna management

Soenen, A.; Vourc’h, Morgane; Khammari, Amir; Nguyen, Jean–Michel; Bossard, Céline; Musquer, Marie Denis; Vergier, Béatrice; Dréno, Brigitte

doi:10.1016/j.jaad.2021.03.077

Cited by 8 publications

(8 citation statements)

References 38 publications

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“…[ 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 . [ 118 ] (2022) CRT 40 21 (+ 19 with placebo) μ = 60.5 LM: face, neck, or scalp H Imiquimod 5% once/d 5 t/w for 4 w NR Complete: 13 (H) NA NA Ishioka et al . [ 119 ] (2022) CS 6 6 – LM: face (3), scalp (2), back (1) H Imiquimod 5% once/d 6 t/w for 12 w NR Complete (CM) NA NA Seyed Jafari et al .…”

Section: Resultsmentioning

confidence: 99%

“…Seventeen studies [ 16 , 53 , 62 , 63 , 68 , 74 , 80 , 90 , 97 , 98 , 101 , 103 , 108 , 115 – 117 , 119 ] mentioned the importance of the (video)dermoscopy for diagnosis and follow-up and to guide the biopsies. In addition, seven studies [ 74 , 82 , 92 , 98 , 100 , 118 , 119 ] mentioned or used the reflectance confocal microscopy.…”

Section: Resultsmentioning

confidence: 99%

“…Indeed, this clinical aspect makes it difficult to assess an incomplete clearance and often leads to a post-treatment surgery. The actual evidence does not lead to avoidance of a final biopsy or surgery in these cases, but some authors raised the importance of non-invasive methods, such as dermoscopy [ 16 , 53 , 62 , 63 , 68 , 74 , 80 , 90 , 97 , 98 , 101 , 103 , 108 , 115 – 117 , 119 ] and confocal microscopy [ 74 , 82 , 92 , 98 , 100 , 118 , 119 ], with the latter preferable in terms of histopathological criteria [ 121 ] but less available in daily practice. Treatment with imiquimod is non-invasive, but at the present time an initial biopsy to ensure that the melanoma is non-invasive is mandatory and a biopsy when there is suspicion of partial/absent response or relapse are preferred.…”

Section: Discussionmentioning

confidence: 99%

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

Vaienti,

Calzari,

Nazzaro

2023

Dermatol Ther (Heidelb)

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Introduction The classical management of melanoma is surgery, but this can be challenging because of several factors, such as age, body area, lesion size, among others. Topical imiquimod may be a therapeutic option for the treatment of melanoma in situ and lentigo maligna melanoma due to its efficacy, tolerability, and non-invasiveness. The purpose of this systematic review is to assemble current evidence on the treatment of non-metastatic melanoma with topical imiquimod. Methods The PubMed/MEDLINE and Cochrane Library databases were searched as the primary sources using the main search terms “imiquimod” combined with “lentigo maligna” and “melanoma” with the command “AND.” Articles were identified, screened, and extracted for relevant data, following the PRISMA guidelines. Results A total of 87 studies covering 1803 lesions treated with imiquimod cream were identified and included in this sytematic review. Forty-nine studies were case reports, 16 were retrospective analyses, 3 were open label trials, six were case series; one study was a controlled randomized trial, one was a randomized trial, and one was a single-arm phase III trial. Because of the high number of low-evidence studies, the overall risk of bias resulted high. In 55 studies, imiquimod 5% was used in monotherapy as the primary treatment; only in one study was imiquimod 3.75% introduced. In most cases, the topical treatment was applied once daily, with the exception of nine cases where an increased daily dosage was prescribed. The total duration of the treatment regimen was extremely variable and depended on body area and tolerability, with differences among patients of the same study. In six studies, imiquimod was used as neoadjuvant therapy before the surgical excision, and in 11 studies it was used after surgery as complementary or adjuvant therapy. In total, 1133 of the 1803 (62.8%) lesions were reported to be cleared after the treatment, taking into account that not all of the patients completed the treatment. Of these 1133 lesions, histological clearance was achieved in 645 (56.9%) lesions and clinical clearance only was achieved in 490 (43.2%) lesions; relapse occurred in 107 lesions. Conclusions The heterogeneity of the studies included in this systematic review precludes the drawing of any relevant conclusions regarding the application of imiquimod. Its efficacy in melanoma in situ and lentigo maligna melanoma has been demonstrated, but further evidence from controlled studies concerning the modalities is missing.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Vaienti,

Calzari,

Nazzaro

2023

Dermatol Ther (Heidelb)

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“…RCM can be used to diagnose and assess the margins of lentigo maligna, a slow-growing subtype of melanoma. Imiquimod can be used in the treatment of lentigo maligna, and RCM was used to determine the lentigo maligna score (LMS) of lesions treated with imiquimod vs. those treated with placebo after one month of treatment [ 4 ]. This imaging modality also exhibited better sensitivity and specificity than multispectral digital skin lesion analysis (MDSLA) when comparing the efficacy in the detection of melanomas.…”

Section: Reviewmentioning

confidence: 99%

Utilization of Imaging Modalities in the Diagnosis of Melanoma: A Scoping Review

Shapiro,

Basra,

Patel

et al. 2024

Cureus

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Melanomas arise de novo or in the context of a precursor lesion. Lesions typically grow radially and then undergo a vertical growth phase proceeding to local invasion and metastasis. This review describes the utility of different imaging modalities in diagnosis and melanocytic lesion monitoring. A literature search was performed in November 2023 utilizing EMBASE, Medline, and PubMed. The PRISMA diagram demonstrates the review process. Reflectance confocal microscopy (RCM) utilizes near-infrared light to help diagnose dermatologic lesions. RCM was found to demonstrate nearly two times the positive predictive value compared to dermoscopy. The introduction of the Berlin Ultrasound (US) Morphology Criteria permitted a 65-80% improvement in diagnostic sensitivity. US with fine-needle aspiration cytology (FNAC) accurately predicts the necessity for sentinel lymph node biopsy and lymphadenectomy, sparing patients with metastasis and prompting biopsy for equivocal lesions. Single-photon emission computed tomography/computed tomography (SPECT/CT) is an adjunctive tool to anatomically and functionally assess lymphatic invasion. SPECT/CT improves the detection of sentinel nodes while decreasing operating time and improving cosmetic outcomes. 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) with small voxel reconstruction demonstrated increased specificity and sensitivity for detecting in-transit metastases of melanomas, specifically in the limbs. Dermoscopy allows providers to cost-effectively recognize common lesion patterns. Multiphoton microscopy assigns a weight-based score based on malignant features. Optical coherence angiography captures images of vessels to help diagnose equivocal lesions. Utilization of imaging techniques may increase diagnostic accuracy, reduce unnecessary procedures, and help guide treatment plans. Additional research is needed to further characterize the utility of these techniques in order to improve the diagnosis and treatment of melanomas.

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“…RCM was concordant with histology in 19 of 21 patients (90%) with no false negatives. 11 Current data demonstrate that imiquimod can be effectively utilised in the treatment of LM. This review is limited by varying follow-up times for long-term tumour recurrence monitoring.…”

mentioning

confidence: 96%

Management of lentiginous melanoma with imiquimod assessed by reflectance confocal microscopy

Han

Tai

Poplausky

et al. 2023

Skin Health and Disease

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Change in lentigo maligna score assessed by in vivo reflectance confocal microscopy after 1 month of imiquimod treatment for lentigo maligna management

Cited by 8 publications

References 38 publications

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

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

Utilization of Imaging Modalities in the Diagnosis of Melanoma: A Scoping Review

Management of lentiginous melanoma with imiquimod assessed by reflectance confocal microscopy

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