Imiquimod and lentigo maligna: a search for prognostic features in a clinicopathological study with long-term follow-up

Abstract

We consider imiquimod to have a role in the treatment of LM in patients in whom surgery may be contraindicated or for those in whom the cosmetic or functional consequences may be considerable. Until better characterized, its use should probably be confined to centres with experience in the detection and treatment of LM and melanoma.

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

“…No standardized application protocol exists, to our knowledge, and our results are limited to a treatment regimen of 5 days per week for 12 weeks, which is similar to that of 9 other studies 2,3,6,8,9,25,26,36,37 that used treatment duration of 12 weeks but with variable application fre- quencies. Our results also may be limited by surgical excision being performed at a mean of 23 (range, 1-73) days after treatment cessation because the presence of histopathologic inflammation may reduce assessment accuracy.…”

Topical treatment of cutaneous metastases of malignant melanoma using combined imiquimod and 5-fluorouracil

“…Powell et al consider a patient's ability to develop an inflammatory reaction to imiquimod as a strong predictor of therapeutic benefit in treatment of melanoma in situ [17]. In our study, all complete responses were preceded by ulceration.…”

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

“…11 However, imiquimod remains an off-label indication for melanoma because of the lack of randomized, prospective trials demonstrating its efficacy compared with conventional surgery. 7,13,[17][18][19][20] A thorough discussion of risks and benefits is necessary so that patients/families understand the limitations of treatment with imiquimod over standard surgical resection, including the risk of missing or undertreating invasive melanoma, local recurrence caused by lack of histologic margin control, and absence of long-term randomized controlled trials or comparative studies. 11 Close follow-up is recommended in patients treated with imiquimod, along with a low threshold to perform ''scouting'' biopsies after treatment and biopsy of any recurrent pigmentation in imiquimod-treated sites.…”

“…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.…”