Practical application of laser reflectance confocal microscopy in the follow-up of patients with lentigo maligna undergoing treatment with Imiquimod

Ishioka, Priscila; Costa, Lilian Lemos; Maia, Marcus

doi:10.1016/j.abd.2021.01.008

Cited by 1 publication

(4 citation statements)

References 10 publications

(19 reference statements)

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“…[ 118 ] (2022) CRT 40 21 (+ 19 with placebo) μ = 60.5 LM: face, neck, or scalp H Imiquimod 5% once/d 5 t/w for 4 w NR Complete: 13 (H) NA NA Ishioka et al . [ 119 ] (2022) CS 6 6 – LM: face (3), scalp (2), back (1) H Imiquimod 5% once/d 6 t/w for 12 w NR Complete (CM) NA NA Seyed Jafari et al . [ 12 ] (2023) RA 114 114 38–93 Median = 72 LM: cheek (49), nose (32), temporo-auricular (14), forehead (6), orbital (5), other face/head areas (3), other (5) H Imiquimod 5% once-twice/d until weeping erosion (1–55 w) NR Complete: 111 (C) None: 3 (C) 15–16.8 y 23 (H) For each study the following items were considered: number of treated lesions; diagnosis (LM/MIS/LMM) with the body area; diagnostic method (histology/clinics); protocol; margins of the lesions included in treated area; response after the treatment specifying the verification method (complete/partial/none; histology/clinical/other); time of long-term follow-up (as range or average time); number of relapses specifying the verification method (histology/clinical/other) at the time of the long-term follow-up.…”

Section: Resultsmentioning

confidence: 99%

“…Of the 1133 lesions, histological clearance was achieved in 645 (56.9%) lesions and clinical clearance only was achieved in 490 (43.2%) lesions. For 34 lesions, the initial clearance was tested with the confocal microscopy [ 98 , 119 ] and (1 case) with videodermoscopy [ 63 ].…”

Section: Resultsmentioning

confidence: 99%

“…Seventeen studies [ 16 , 53 , 62 , 63 , 68 , 74 , 80 , 90 , 97 , 98 , 101 , 103 , 108 , 115 – 117 , 119 ] mentioned the importance of the (video)dermoscopy for diagnosis and follow-up and to guide the biopsies. In addition, seven studies [ 74 , 82 , 92 , 98 , 100 , 118 , 119 ] mentioned or used the reflectance confocal microscopy.…”

Section: Resultsmentioning

confidence: 99%

“…Indeed, this clinical aspect makes it difficult to assess an incomplete clearance and often leads to a post-treatment surgery. The actual evidence does not lead to avoidance of a final biopsy or surgery in these cases, but some authors raised the importance of non-invasive methods, such as dermoscopy [ 16 , 53 , 62 , 63 , 68 , 74 , 80 , 90 , 97 , 98 , 101 , 103 , 108 , 115 – 117 , 119 ] and confocal microscopy [ 74 , 82 , 92 , 98 , 100 , 118 , 119 ], with the latter preferable in terms of histopathological criteria [ 121 ] but less available in daily practice. Treatment with imiquimod is non-invasive, but at the present time an initial biopsy to ensure that the melanoma is non-invasive is mandatory and a biopsy when there is suspicion of partial/absent response or relapse are preferred.…”

Section: Discussionmentioning

confidence: 99%

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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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