Immunocryosurgery as monotherapy for lentigo maligna or combined with surgical excision for lentigo maligna melanoma

Abstract

The incidence of lentigo maligna (LM), in situ (LM) or invasive (lentigo maligna melanoma, LMM), has increased during the last decades. Due to functional or cosmetic outcomes, optimal treatment with surgical excision may not be appropriate in some cases. We tried less invasive therapy, immunocryosurgery, as a single treatment for LM or combined with surgery for LMM, with better aesthetic results. Three patients with LM or LMM not amenable to complete surgical excision were selected. LMM patients underwent limited surgical resection of the invasive area. Subsequently, a combined treatment with topical imiquimod and cryosurgery was performed. The LM patient received immunocryosurgery directly. All of them were free of local and systemic disease at 48, 42 and 41 months after discontinuation of therapy. We consider that immunocryosurgery is an alternative option for LM or even for LMM (after removal of the invasive tissue with narrow margins) in poor surgical candidates, with good therapeutic, functional and cosmetic results.

<p>Lentigo Maligna: Clinical Presentation and Appropriate Management</p>

“…118 Different regimes have been applied with variable results. Matas-Nadal et al 119 used topical imiquimod 5% cream once daily on the lesion plus 1 cm along the lesion edge for 3 weeks, followed by one session of cryosurgery (2 cycles of 20 seconds) on the lesion plus 1 cm along the lesion edge. This was followed by 6 months of topical imiquimod cream 3 times per week.…”

Long‐term outcomes of imiquimod‐treated lentigo maligna: add on cryosurgery to induce inflammation and increase efficacy?

“…The resulted complete clearance has persisted for > 4 years. The efficacy of immunocryosurgery for LM is corroborated by the established feasibility and efficacy of this method in basal cell carcinoma. We suggest that at least a subset of the patients who do not respond with inflammation to daily imiquimod, such as those reported by Pananikolaou and Lawrence, would achieve the required inflammatory response with a relatively mild cryosurgery session during continued application of imiquimod.…”

“…We wish to draw attention to the potential of cryosurgery sessions during ongoing imiquimod application, which we have termed ‘immunocryosurgery’, to burst inflammation and induce relevant alterations in the inflammatory infiltrate of basal cell carcinomas at the tissue and blood (unpublished data) levels. However, this also applies to the treatment of LM as demonstrated in cases reported by us and others . In addition, we applied cryosurgery to incite local inflammation, combined with daily application of imiquimod in order to shorten the treatment period, in exemplary cases of LM.…”

Treatment of lentigo maligna (Review)

“…Lentigo maligna (LM), also known as malignant freckle, Hutchinson's melanotic freckle, Melanosis circumscripta precancerosa of Dubreuilh or melanoma in situ-LM type, is the most common clinicopathological subtype of in situ malignant melanoma (MM), accounting [along with lentigo maligna melanoma (LMM), its invasive counterpart] for 4-15% of all MM cases (1). Its incidence has been recently increasing worldwide, including in Europe (2,3), the USA (1) and Australia (4), as a consequence of ageing and the increased sun exposure of the population over the past decades. Australia seems to have the highest incidence of LM, estimated at 12.2 per 100,000 individuals (4).…”