Efficacy of Imiquimod Cream, 5%, for Lentigo Maligna After Complete Excision

Abstract

Setting: A multidisciplinary melanoma clinic at a major tertiary hospital.Patients: Forty-three patients with biopsy-proven LM of greater than 5 mm in diameter completed this study.Interventions: Imiquimod cream, 5%, was applied to the lesion 5 days a week for 12 weeks. The original lesion was excised with a 5-mm margin. Main Outcome Measures:The primary outcome was histopathologic evidence of LM in the excision specimen assessed independently by 2 of 3 dermatopathologists. Visible inflammation during treatment and macroscopic clearance were recorded.

A quantitative systematic review of the efficacy of imiquimod monotherapy for lentigo maligna and an analysis of factors that affect tumor clearance

“…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 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).…”

Lentigo Maligna and Lentigo Maligna Melanoma: Contemporary Issues in Diagnosis and Management

“…This treatment has been recently reported as a potentially effective second-line treatment for LM, however, evidence for this treatment is still in preliminary stages. Typical regimens range from three-times weekly treatment to daily treatment for 2 weeks to 7 months [58][59][60]. A brisk inflammatory reaction is often seen and is desired as this is thought to correspond with immunologic response [61].…”

“…An interventional study by Ly et al in which imiquimod 5% cream was applied five-times weekly for 12 weeks followed by excision demonstrated histopathologic clearance in 53% of patients, with poor concordance between macroscopic and histopathologic clearance [59]. However, a review article including 264 patients treated with various regimens reported 82% clinical or histologic clearance.…”

“…This analysis was limited in that the majority of reports were case reports or series, with some uncontrolled trials [62]. Topical imiquimod has been used both preoperatively and postoperatively as an adjunct to surgical treatment with variable results [58][59]63]. Topical tazarotene 0.1% gel has also been used alone and in conjunction with topical imiquimod with resulting increased inflammation, however, this has not been shown to increase efficacy in clearing LM.…”

Imiquimod 5% cream as primary or adjuvant therapy for melanoma in situ, lentigo maligna type

“…Robust inflammation at imiquimod-treated sites has been reported as a possible prognostic factor of improved response for LM. 10,13 Our study aimed to determine the long-term effectiveness of imiquimod as primary or adjuvant treatment of LM and to examine the differences and potential significance of the inflammatory reaction in a retrospectively identified cohort of patients.…”