title: In vivo reflectance confocal microscopy to monitor the response of lentigo maligna to imiquimod.
abstract: BACKGROUND
  Imiquimod has been used for treating lentigo maligna (LM) in selected cases when surgery is not an appropriate option because of functional or aesthetic impairment. Reflectance confocal microscopy (RCM) is a noninvasive method that has not been validated for monitoring the treatment of LM with imiquimod.
  
  
  OBJECTIVE
  We sought to evaluate the use of in vivo RCM to accurately monitor the response of LM to nonsurgical treatment with topical imiquimod.
  
  
  METHODS
  Twenty patients with confirmed facial LM, not amenable to surgical treatment or radiation therapy, were included prospectively. Clinical evaluation was performed by dermoscopy, RCM, and histopathology. Patients applied imiquimod 5% for 8 weeks. The affected area was assessed using the previously described LM score on RCM, and target sample biopsies were performed to confirm or discard RCM findings.
  
  
  RESULTS
  Fifteen of the 20 patients (75%) presented histologic tumor clearance. Confocal microscopy identified 70% of these responders with no false-negative results, and when compared with histopathology, there was no significant difference in evaluating the response to imiquimod.
  
  
  CONCLUSIONS
  The impossibility of examining the entire lesion by means of histopathology is a limitation.
  
  
  CONCLUSIONS
  In vivo RCM evaluation was useful in accurately monitoring the response of LM to nonsurgical treatment with topical imiquimod in patients when surgery is contraindicated.
authors.affiliation: Dermatology Department, Melanoma Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Institut de Recerca Biomédica August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: Ivette
authors.initials: I
authors.lastname: Alarcon
authors.affiliation: Dermatology Department, Melanoma Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Institut de Recerca Biomédica August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Carrera
authors.affiliation: Pathology Department, Melanoma Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain.
authors.forename: Llucia
authors.initials: L
authors.lastname: Alos
authors.affiliation: Pathology Department, Melanoma Unit, Hospital Clinic of Barcelona, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Palou
authors.affiliation: Dermatology Department, Melanoma Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Institut de Recerca Biomédica August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Malvehy
authors.affiliation: Dermatology Department, Melanoma Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Institut de Recerca Biomédica August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain. Electronic address: susipuig@gmail.com.
authors.forename: Susana
authors.initials: S
authors.lastname: Puig
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000634:Aminoquinolines / Q000008:administration & dosage / Q000627:therapeutic use*; D046169:Dermoscopy; D005153:Facial Neoplasms / Q000188:drug therapy*; D005260:Female; D006801:Humans; D018327:Hutchinson's Melanotic Freckle / Q000188:drug therapy*; D000077271:Imiquimod; D008297:Male; D018613:Microscopy, Confocal / Q000379:methods*; D008875:Middle Aged; D056687:Off-Label Use; D011446:Prospective Studies; D012878:Skin Neoplasms / Q000188:drug therapy*
chemical_list: D000276:Adjuvants, Immunologic; D000634:Aminoquinolines; D000077271:Imiquimod
keywords: dermoscopy; imiquimod; lentigo maligna; melanoma; noninvasive diagnosis; nonsurgical treatment; reflectance confocal microscopy