Efficacy of 5% Imiquimod Cream on Vulvar Intraepithelial Neoplasia in Korea: Pilot Study

Abstract

BackgroundVarious therapeutic options, including surgery, electrocautery, cryotherapy, 5-fluorouracil treatment, laser therapy, radiotherapy, photodynamic therapy, and interferon-α/γ injection, have been employed to treat vulvar intraepithelial neoplasia (VIN) with varying degrees of success. To truly cure VIN, human papillomavirus elimination is considered important.ObjectiveTo investigate the efficacy of 5% imiquimod cream used to treat VIN in Korean patientsMethodsWe performed a prospective, uncontrolled, observational study. Nine patients with histologically confirmed VIN applied 5% imiquimod cream to their vulvar lesions three to five times a week until a clinical response was apparent. All lesions were photo-documented, and therapeutic efficacy was assessed in terms of local adverse effects lesion number, size, and hyperpigmentation.ResultsThe mean treatment duration was 30.2 months, and the median follow-up period after therapy completion was 30 months. Of the nine patients recruited, six (66.6%) experienced complete responses (CR) or partial responses (PR). Hyperpigmented patches in the VIN lesions were evident in five subjects (55.6%), and all experienced either CR or PR. Only three patients (33.3%) suffered from local adverse effects, which were relieved after temporary suspension of therapy, and better outcomes were attained ultimately.ConclusionThe imiquimod cream was more efficacious when used to treat VIN of the hyperpigmented type compared with lesions lacking pigmentation. The unifocal nature of a lesion and the development of local adverse effects are useful factors when imiquimod cream is prescribed. However, although the cream is convenient and effective, regional resistance may develop, and close follow-up is essential because VIN may become malignant.

Dermoscopic findings of vulvar intraepithelial neoplasia: a series of four cases

“…Dermoscopic features of VIN have rarely been described. Ten to 15% of cases of VIN are hyperpigmented . Ronger‐Savle et al .…”

“…The term ‘vulvar intraepithelial neoplasia’ refers to a variety of pathological conditions with different severity grades and a prevalence of 1 case per 100 000 women/year . Histopathologically, VIN represents an in situ SCC of the vulva, with moderate‐to‐severe dysplasia …”

“…1,2 Histopathologically, VIN represents an in situ SCC of the vulva, with moderate-to-severe dysplasia. 3 The World Health Organization has identified three different grades of VIN (I, II and III) on the basis of the level of atypia within the squamous epithelium. 1 Grade I VIN is characterized by atypia involving less than one-third of the squamous epithelium thickness, grade II VIN between one-third and two-thirds, and grade III VIN more than two-thirds.…”

Imiquimod Induces Apoptosis in Human Endometrial Cancer Cells In vitro and Prevents Tumor Progression In vivo

“…Recently, IQ was found to also exhibit antitumor effects against different malignancies such as prostate and urothelial cell carcinoma (30, 31). Clinical trials further demonstrated that IQ is effective in the treatment of vulvar, cervical, and vaginal intraepithelial neoplasias (32–34). IQ exhibits antitumor activity presumably by inducing apoptosis through direct and indirect pathways (35).…”

Successful management of recalcitrant perianal warts with two sessions of intralesional 5-fluorouracil

“…In some patients, although, there could be lack of response following imiquimod usage, which has been attributed to regional drug resistance. [6] Recently, intralesional usage of 5-FU at weekly intervals has been utilized for GW. [34] I, however, utilized 5-FU on a monthly basis.…”