title: Cryosurgery during topical imiquimod: a successful combination modality for lentigo maligna.
abstract: BACKGROUND
  Either cryosurgery or topical imiquimod have been used to treat patients with lentigo maligna in cases where surgery is not feasible.
  
  
  METHODS
  We report a patient with lentigo maligna, who was treated with the combination of topical imiquimod and cryosurgery, and review the rationale, which led us to design the present combined cryo-immunological treatment modality.
  
  
  RESULTS
  Sustained clearance of lentigo maligna to date (26 months after treatment). The successful treatment of this patient was based on the following rationale: A cryosurgery session during continuing imiquimod application may: (i) reinforce apoptosis of tumor cells; (ii) strengthen antiangiogenesis in the treated tumor; and (iii) build-up a potent tumor-destructive immune response by a cascade of events starting with imiquimod-promoted attraction of immature dendritic antigen-presenting cells (DCs) into the tumor. DCs further mature within the tumor-antigen-rich environment of subsequently cryo-destructed tumor and upon imiquimod-driven migration into the peripheral lymph nodes can stimulate a specific antineoplastic cell-mediated immunity. Finally, continuing imiquimod application after cryosurgery may increase recruitment of activated effector cells into the tumor tissue leading to its destruction.
  
  
  CONCLUSIONS
  Cryosurgery during continued topical imiquimod seems to be a promising treatment for lentigo maligna.
authors.affiliation: Department of Skin and Venereal Diseases, and the Department of Pathology, University of Ioannina Medical School, Ioannina, Greece. ibassuka@cc.uoi.gr
authors.forename: I D
authors.initials: ID
authors.lastname: Bassukas
authors.forename: C
authors.initials: C
authors.lastname: Gamvroulia
authors.forename: A
authors.initials: A
authors.lastname: Zioga
authors.forename: K
authors.initials: K
authors.lastname: Nomikos
authors.forename: C
authors.initials: C
authors.lastname: Fotika
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage*; D000279:Administration, Cutaneous; D000368:Aged; D000634:Aminoquinolines / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D003452:Cryosurgery; D006801:Humans; D018327:Hutchinson's Melanotic Freckle / Q000628:therapy*; D000077271:Imiquimod; D008297:Male; D012878:Skin Neoplasms / Q000628:therapy*
chemical_list: D000276:Adjuvants, Immunologic; D000634:Aminoquinolines; D000077271:Imiquimod