Observational Study of Topical Imiquimod Immunotherapy in the Treatment of Difficult Lentigo Maligna

Craythorne, Emma; Lawrence, C.M.

doi:10.4137/cmo.s690

Cited by 3 publications

(3 citation statements)

References 20 publications

(29 reference statements)

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“…Similar results were also obtained by Craythorne and Lawrence (37), who demonstrated that in 6/8 LM patients treated with imiquimod, the tumor resolved clinically with no evidence of recurrence after a mean follow up period of 34.2 months. A brisk inflammatory reaction was a prerequisite of therapeutic response (37).…”

Section: Imiquimod In Lmsupporting

confidence: 76%

Toll-like receptors and cutaneous melanoma

et al. 2016

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Abstract. Innate immune cells recognize highly conserved pathogen-associated molecular patterns (PAMPs) via pattern recognition receptors (PRRs). Previous studies have demonstrated that PRRs also recognize endogenous molecules, termed damage-associated molecular patterns (DAMPs) that are derived from damaged cells. PRRs include Toll-like receptors (TLRs), scavenger receptors, C-type lectin receptors and nucleotide oligomerization domain-like receptors. To date, 10 TLRs have been identified in humans and each receptor responds to a different ligand. The recognition of PAMPS or DAMPs by TLRs leads to the activation of signaling pathways and cellular responses with subsequent pro-inflammatory cytokine release, phagocytosis and antigen presentation. In the human skin, TLRs are expressed by keratinocytes and melanocytes: The main cells from which skin cancers arise. TLRs 1-6 and 9 are expressed in keratinocytes, while TLRs 2-5, 7, 9 and 10 have been identified in melanocytes. It is hypothesized that TLRs may present a target for melanoma therapies. In this review, the involvement of TLRs in the pathogenesis and treatment of melanoma was discussed.

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Section: Imiquimod In Lmsupporting

confidence: 76%

Toll-like receptors and cutaneous melanoma

et al. 2016

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“…[ 60 ] (2008) RA 40 40 49–92 μ (male) = 72 μ (female) = 68 LM: cheek (14), nose (6), temple (5), scalp (5), ear (3), extremity (2), trunk (2), chin (1), forehead (1), neck (1) H Imiquimod 5% once/d 5 t/w or daily for 12 w ± 0.1% tazarotene gel once during the weekend after the first month in the absence of erythema + staged excision (margins 2 mm) 2 Complete: 30 (H) Partial/none: 10 (H) 12–34 m 0 (C) Craythorne et al . [ 61 ] (2008) OLT 8 8 50–92 μ = 67.25 LM: nose (3), forehead (1), cheek (2), scalp (1), ear (1) H Imiquimod 5% once/d 5 t/w or daily for 6–12 w 1 Complete: 1 (H), 6 (C) None: 1 (H) 2–63 m 2 (H) De Troya Martín et al . [ 62 ] (2008) CR 2 2 89–93 LM: ear, chin H Imiquimod 5% once/d 5–7 t/w for 12 w NR Complete (H) 36 m 0 (C) Micali et al [ 63 ] (2008) CR 2 2 39–48 LM: nose (2) H (case 1) C (case 2) Imiquimod 5% once/d 5–7 t/w overnight for 16 w 0.5 Complete (VD) 30 m 0 (C) Mahoney et al .…”

Section: Resultsmentioning

confidence: 99%

Topical Treatment of Melanoma In Situ, Lentigo Maligna, and Lentigo Maligna Melanoma with Imiquimod Cream: A Systematic Review of the Literature

Vaienti,

Calzari,

Nazzaro

2023

Dermatol Ther (Heidelb)

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Introduction The classical management of melanoma is surgery, but this can be challenging because of several factors, such as age, body area, lesion size, among others. Topical imiquimod may be a therapeutic option for the treatment of melanoma in situ and lentigo maligna melanoma due to its efficacy, tolerability, and non-invasiveness. The purpose of this systematic review is to assemble current evidence on the treatment of non-metastatic melanoma with topical imiquimod. Methods The PubMed/MEDLINE and Cochrane Library databases were searched as the primary sources using the main search terms “imiquimod” combined with “lentigo maligna” and “melanoma” with the command “AND.” Articles were identified, screened, and extracted for relevant data, following the PRISMA guidelines. Results A total of 87 studies covering 1803 lesions treated with imiquimod cream were identified and included in this sytematic review. Forty-nine studies were case reports, 16 were retrospective analyses, 3 were open label trials, six were case series; one study was a controlled randomized trial, one was a randomized trial, and one was a single-arm phase III trial. Because of the high number of low-evidence studies, the overall risk of bias resulted high. In 55 studies, imiquimod 5% was used in monotherapy as the primary treatment; only in one study was imiquimod 3.75% introduced. In most cases, the topical treatment was applied once daily, with the exception of nine cases where an increased daily dosage was prescribed. The total duration of the treatment regimen was extremely variable and depended on body area and tolerability, with differences among patients of the same study. In six studies, imiquimod was used as neoadjuvant therapy before the surgical excision, and in 11 studies it was used after surgery as complementary or adjuvant therapy. In total, 1133 of the 1803 (62.8%) lesions were reported to be cleared after the treatment, taking into account that not all of the patients completed the treatment. Of these 1133 lesions, histological clearance was achieved in 645 (56.9%) lesions and clinical clearance only was achieved in 490 (43.2%) lesions; relapse occurred in 107 lesions. Conclusions The heterogeneity of the studies included in this systematic review precludes the drawing of any relevant conclusions regarding the application of imiquimod. Its efficacy in melanoma in situ and lentigo maligna melanoma has been demonstrated, but further evidence from controlled studies concerning the modalities is missing.

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“…Clinical recurrences following primary IMQ therapy develop in 4-24% of cases after an average of 3.2 years (72-74) and seem to be more common for LM of the nose (75). The development of an inflammatory reaction to IMQ seems to be associated with a better clinical and histological response (64,(76)(77)(78), contrary to lesion size and treatment duration. Factors found to be predictive of local recurrence include the total number of melanocytes, the number of basal and suprabasal melanocytes and the number of pagetoid spreading melanocytes (73).…”

Section: Radiotherapy (Rt)mentioning

confidence: 99%

Treatment of lentigo maligna (Review)

Kanitakis

2021

World Acad Sci J

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Lentigo maligna (LM) is the most common type of in situ melanoma, usually appearing on chronically sun-exposed skin (mostly the head and neck) of elderly patients. It manifests clinically as a macule with a heterogeneous pigmentation and irregular contours. LM grows gradually over the years in a radial pattern and may eventually progress with a vertical growth phase, thereby transforming into an invasive melanoma (LM melanoma) that has potential for metastasis and a lethal outcome; accordingly, LM is currently regarded as an authentic melanoma in situ, rather than a premalignant condition. To the best of my knowledge, no prospective, randomized controlled studies evaluating the efficacy of the various treatment modalities applied for the treatment of LM exist to date. Surgical excision with tumour-free margins is regarded as the most effective treatment, achieving optimal rates of tumour clearance. Excision can be performed as traditional, one-step tumour ablation with predefined safety margins or, preferably, with margin-controlled techniques, such as staged excision or Mohs micrographic surgery, the latter methods achieving the highest cure rates. In the case of surgically-unresectable tumours or in frail patients with severe comorbidities, alternative non-surgical (off-label) therapies can be applied, including namely radiotherapy and imiquimod, as monotherapy or in various combinations.

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Observational Study of Topical Imiquimod Immunotherapy in the Treatment of Difficult Lentigo Maligna

Cited by 3 publications

References 20 publications

Toll-like receptors and cutaneous melanoma

Toll-like receptors and cutaneous melanoma

Topical Treatment of Melanoma In Situ, Lentigo Maligna, and Lentigo Maligna Melanoma with Imiquimod Cream: A Systematic Review of the Literature

Treatment of lentigo maligna (Review)

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