Imiquimod: a novel treatment for lentigo maligna

Abstract

Lentigo maligna is the in situ phase of lentigo maligna melanoma, and if left untreated it may progress to invasive melanoma. It most commonly occurs on the exposed sites of the face and neck of middle-aged or elderly patients. Conventional surgery using a 5-10 mm margin is the recommended treatment; however, lesions can be quite large and surgical removal may involve extensive plastic repair. We report an elderly patient with a large lentigo maligna on the scalp who was reluctant to have surgery. We tried topical imiquimod 5% cream (Aldara), a local immunomodulator, which has recently become available for the treatment of external genital and perianal warts. Initially used over a test area and then over the whole of the lesion, for a total of 7 months, the imiquimod cream resulted in complete clinical and histological cure. The patient has been followed up for 9 months without evidence of recurrence.

Malignant melanoma: genetics and therapeutics in the genomic era

“…Imiquimod, which is used clinically to treat anogenital human papillomavirus (HPV) infections, also demonstrates anti-tumor activity against numerous benign and malignant human skin neoplasms. Administration of imiquimod as a topical cream has achieved partial or complete regressions in dysplastic nevi, lentigo maligna, basal cell cancers, and melanoma skin metastases (Ahmed and Berth-Jones 2000;Naylor et al 2003;Schon et al 2004;Noel and Kunzle 2005;Zeitouni et al 2005;Dusza et al 2006). Moreover, preliminary evidence suggests that this agent may enhance the potency of anti-melanoma vaccines (Craft et al 2005).…”

Treatment of lentigo maligna with tazarotene 0.1% gel

“…14,15 Topical application of imiquimod, a recently introduced immune response modifier, has been shown to result in complete clinical and histopathologic regression in an 88-year-old woman with LM after 7 months of treatment and in a 50-year-old woman with disseminated cutaneous metastatic melanoma lesions. 8,16 In our 2 patients, tazarotene 0.1% gel demonstrated a high therapeutic efficacy and tolerability for treatment of LM. Complete regression, as assessed by clinical and histopathologic examinations, was observed after 6 and 8 months of treatment, respectively.…”

“…[1][2][3][4][5] A medical approach such as intralesional interferon alfa, topical azelaic acid, and imiquimod can be effective in older patients with compromised general conditions and in lesions that are difficult to excise because of their extension or location. [6][7][8] Tazarotene is an acetylenic retinoid highly selective for the ␤ and ␥ subtypes of retinoid acid receptors, whereas it does not bind to the retinoid X receptors. 9 Soon after its introduction for topical treatment of mild to moderate psoriasis, tazarotene 0.1% gel has been used to treat a variety of cutaneous diseases including congenital ichthyosis, Darier's disease, and basal cell carcinoma with good clinical response.…”

Pharmacotherapy for Skin Disorders in Older People

“…Imiquimod is effective for lentigo maligna, especially if there is extensive involvement of the face, and if surgery would be difficult or poorly tolerated. 57 …”