title: Efficacy of imiquimod cream, 5%, for lentigo maligna after complete excision: a study of 43 patients.
abstract: OBJECTIVE
  To determine the efficacy of imiquimod cream, 5%, in the treatment of lentigo maligna (LM).
  
  
  METHODS
  Open-label before-and-after interventional study.
  
  
  METHODS
  A multidisciplinary melanoma clinic at a major tertiary hospital.
  
  
  METHODS
  Forty-three patients with biopsy-proven LM of greater than 5 mm in diameter completed this study.
  
  
  METHODS
  Imiquimod cream, 5%, was applied to the lesion 5 days a week for 12 weeks. The original lesion was excised with a 5-mm margin.
  
  
  METHODS
  The primary outcome was histopathologic evidence of LM in the excision specimen assessed independently by 2 of 3 dermatopathologists. Visible inflammation during treatment and macroscopic clearance were recorded.
  
  
  RESULTS
  When 5 of the 43 patients with discordant histopathologic assessment of the excision specimen were excluded, 20 of 38 patients (53% [95% confidence interval, 36%-69%]) demonstrated histopathologic clearance of LM after imiquimod treatment. Visible inflammation was significantly associated with histopathologic clearance (P = .04), but the positive predictive value was low (62%). Macroscopic clearance showed some association with histopathologic clearance (P = .11). Dermatopathologist concordance for all 43 specimens was substantial (κ = 0.77; 95% confidence interval, 0.57-0.96).
  
  
  CONCLUSIONS
  Imiquimod cream, 5%, has limited efficacy in the treatment of LM when determined by histopathologic assessment of the entire treated area. The clinical signs of visible inflammation during treatment and apparent lesion clearance cannot be relied on to assess efficacy.
authors: Victorian Melanoma Service, Level 1, Alfred Center, Alfred Health, Commercial Road, Melbourne, Victoria, Australia. lenaly21@yahoo.com.au
authors: Lena
authors: L
authors: Ly
authors: John William
authors: JW
authors: Kelly
authors: Rodney
authors: R
authors: O'Keefe
authors: Tina
authors: T
authors: Sutton
authors: John P
authors: JP
authors: Dowling
authors: Sarah
authors: S
authors: Swain
authors: Marguerite
authors: M
authors: Byrne
authors: Nathan
authors: N
authors: Curr
authors: Rory
authors: R
authors: Wolfe
authors: Alex
authors: A
authors: Chamberlain
authors: Martin
authors: M
authors: Haskett
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000634:Aminoquinolines / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D004643:Emollients / Q000627:therapeutic use; D005260:Female; D006801:Humans; D018327:Hutchinson's Melanotic Freckle / Q000188:drug therapy* / Q000601:surgery; D000077271:Imiquimod; D008297:Male; D008875:Middle Aged; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000634:Aminoquinolines; D000970:Antineoplastic Agents; D004643:Emollients; D000077271:Imiquimod