Topical Imiquimod for Lentigo Maligna: Survival Analysis of 103 Cases With 17 Years Follow-up

Chambers, Meagan; Swetter, Susan M.; Baker, Catherine; Saunders, Elizabeth; Chapman, Michael

doi:10.36849/jdd.5660

Cited by 9 publications

(17 citation statements)

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“…Off-label use of topical imiquimod, a toll-like receptor 7 agonists, is increasingly being advocated in the primary management of LM as an alternative to surgical excision. 77,78 Similarly, imiquimod has also been shown to be of value in reducing final defect size. 79,80 In the study by Sampson et al, 80 all 24 patients who completed imiquimod treatment had negative margins using a 2-mm surgical margin, resulting in a 71% reduction in the required surgical margin.…”

Section: Discussionmentioning

confidence: 99%

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Lentigo maligna (melanoma): A systematic review and meta‐analysis on surgical techniques and presurgical mapping by reflectance confocal microscopy

Elshot

Tio

With

et al. 2023

Acad Dermatol Venereol

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Because of an increased risk of local recurrence following surgical treatment of lentigo maligna (melanoma) (LM/LMM), the optimal surgical technique is still a matter of debate. We aimed to evaluate the effect of different surgical techniques and reflectance confocal microscopy (RCM) on local recurrence and survival outcomes. We searched MEDLINE, Embase and PubMed databases through 20 May 2022. Randomized and observational studies with ≥10 lesions were eligible for inclusion. Bias assessment was performed using the Methodological Index for Non‐Randomized Studies instrument. Meta‐analysis was performed for local recurrence, as there were insufficient events for the other clinical outcomes. We included 41 studies with 5059 LM and 1271 LMM. Surgical techniques included wide local excision (WLE) (n = 1355), staged excision (n = 2442) and Mohs' micrographic surgery (MMS) (n = 2909). Six studies included RCM. The guideline‐recommended margin was insufficient in 21.6%–44.6% of LM/LMM. Local recurrence rate was lowest for patients treated by MMS combined with immunohistochemistry (<1%; 95% CI, 0.3%–1.9%), and highest for WLE (13%; 95% CI, 7.2%–21.6%). The mean follow‐up varied from 27 to 63 months depending on surgical technique with moderate to high heterogeneity for MMS and WLE. Handheld‐RCM decreased both the rate of positive histological margins (p < 0.0001) and necessary surgical stages (p < 0.0001). The majority of regional (17/25) and distant (34/43) recurrences occurred in patients treated by WLE. Melanoma‐associated mortality was low (1.5%; 32/2107), and more patients died due to unrelated causes (6.7%; 107/1608). This systematic review shows a clear reduction in local recurrences using microscopically controlled surgical techniques over WLE. The use of HH‐RCM showed a trend in the reduction in incomplete resections and local recurrences even when used with WLE. Due to selection bias, heterogeneity, low prevalence of stage III/IV disease and limited survival data, it was not possible to determine the effect of the different surgical techniques on survival outcomes.

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Section: Discussionmentioning

confidence: 99%

“…Off‐label use of topical imiquimod, a toll‐like receptor 7 agonists, is increasingly being advocated in the primary management of LM as an alternative to surgical excision 77,78 . Similarly, imiquimod has also been shown to be of value in reducing final defect size 79,80 .…”

Section: Discussionmentioning

confidence: 99%

Lentigo maligna (melanoma): A systematic review and meta‐analysis on surgical techniques and presurgical mapping by reflectance confocal microscopy

Elshot

Tio

With

et al. 2023

Acad Dermatol Venereol

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“…[ 108 ] (2020) CR 1 1 88 LM: nose H Imiquimod 5% once/d 6 t/w for 12 w NR Complete (C) 12 m 0 (C) Chambers et al . [ 109 ] (2021) RA 103 103 38–92 μ = 69 LM: head/neck (95), torso (4), extremities (4) H ± Surgical excision (partial or margins involved) ± Pretreatment with topical 0.1% tazarotene cream (once daily for 2 weeks) Imiquimod 5% once/d 5 t/w (Monday–Friday) for 12 w NR Complete: 96 (H) Partial: 4 (H) None: 3 (H) 0.08–17.1 y 8 (H) Corneli et al . [ 110 ] (2021) CR 2 2 85–81 LMM: cheek, temporal H Serial surgical excision + imiquimod 5% once/d 7 t/w for 6 w NR Complete (C) 10–12 m 0 (C) Fuchs 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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“…[5][6][7] A recent report from Chamber M et al reported a long-term follow-up and found recurrences occurred in only 10.1% of patients (mean time to recurrence 2.9 years (SD: 2.7 years)). 8 To maximise compliance, its potential efficacy and to obtain robust data, it is important that an optimal protocol and procedure for the application of imiquimod for treating LM is followed. Indeed, we consider it likely that variability in the imiquimod application procedures may have impacted the results obtained in different studies published to date.…”

mentioning

confidence: 99%

“…reported a long‐term follow‐up and found recurrences occurred in only 10.1% of patients (mean time to recurrence 2.9 years (SD: 2.7 years)). 8 …”

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confidence: 99%

Re: Reply to letter to the editor re: ‘practical guide on the use of imiquimod cream to treat lentigo maligna’

et al. 2022

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Topical Imiquimod for Lentigo Maligna: Survival Analysis of 103 Cases With 17 Years Follow-up

Cited by 9 publications

References 0 publications

Lentigo maligna (melanoma): A systematic review and meta‐analysis on surgical techniques and presurgical mapping by reflectance confocal microscopy

Lentigo maligna (melanoma): A systematic review and meta‐analysis on surgical techniques and presurgical mapping by reflectance confocal microscopy

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

Re: Reply to letter to the editor re: ‘practical guide on the use of imiquimod cream to treat lentigo maligna’

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