Treatment of Lentigo Maligna with Imiquimod before Staged Excision

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.…”

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

“…17,20 An efficacy rate of 50% based on 10 patients followed up for a mean of 33 months (range, 11-56 months) has been recently reported. 21 Two previous studies 2,4 based on histopathologic assessment of the complete surgical excision specimen reported histopathologic clearance rates of 67% (4 of 6) and 75% (30 of 40) ( Table 2). Their efficacy rates and our rate of 53% (20 of 38) are noted to be lower than those of other studies, 1,3,[5][6][7][8][9][10][11][12][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] which used partial biopsy findings or macroscopic clearance to assess efficacy.…”

Melanoma in situ

“…59,74-76 In 1 study of 40 patients, use of imiquimod 5 times a week for 3 months before staged excision resulted in no recurrences at 18 months. 75 Patients who use imiquimod plus tazarotene may have even better responses compared to the use of imiquimod alone. 59 However, there is a lack of randomized controlled trials examining the use of imiquimod with or without tazarotene before surgery compared with surgery alone.…”