Topical 5% imiquimod in the treatment of lentigo maligna.
BACKGROUND
Standard treatment for lentigo maligna (LM) is surgical excision with 5 to 10 mm margins. This can be cosmetically disfiguring. Imiquimod locally induces Toll-like receptors to release cytokines that destroy neoplastic melanocytes.


OBJECTIVE
The off-label use of topical 5% imiquimod cream may provide an alternative to surgery. This study reviews the use of imiquimod to treat LM.


METHODS
A 5-year retrospective and prospective chart analysis was conducted. Pretreatment biopsies confirmed the diagnosis. Treatment was individualized for each patient. Posttreatment biopsies and dermoscopy determined clearance of LM.


RESULTS
Twenty-seven patients were reviewed. There were 20 responders (74.1%) and 7 failures. The mean tumor size (area of an ellipse) was 6.69 cm2, and the mean treatment duration was 17.68 weeks. Neither the size of the tumor (p  =  .86) nor treatment duration (p  =  .18) was related to resolution of the lesion.


CONCLUSIONS
Imiquimod is an effective treatment for LM that provides patients with a cosmetically favorable outcome when standard surgery is not an option.
Department of Internal Medicine and Dermatology, University of Manitoba, Winnipeg, MB.
Jessica G
JG
Wong
Jack W P
JW
Toole
Alain A
AA
Demers
Grace
G
Musto
Marni C
MC
Wiseman
D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000634:Aminoquinolines / Q000008:administration & dosage / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001706:Biopsy; D046169:Dermoscopy; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D018327:Hutchinson's Melanotic Freckle / Q000188:drug therapy* / Q000473:pathology; D000077271:Imiquimod; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome
D000634:Aminoquinolines; D000970:Antineoplastic Agents; D000077271:Imiquimod