title: Imiquimod 5% cream as primary or adjuvant therapy for melanoma in situ, lentigo maligna type.
abstract: BACKGROUND
  Surgical resection of lentigo maligna (LM) is complicated by noncontiguous, subclinical extension and actinic melanocytic hyperplasia in sun-damaged skin of older individuals.
  
  
  OBJECTIVE
  We sought to determine the long-term effectiveness of imiquimod as primary or adjuvant therapy for LM.
  
  
  METHODS
  Patients were retrospectively identified from January 1, 2003, to December 31, 2013, with LM, early/evolving LM, and LM melanoma who had used topical imiquimod 5% cream for either primary therapy after diagnostic biopsy, or adjuvant therapy after narrow-margin surgical resection or complete clinical but not histologic resection of LM. Follow-up occurred through December 31, 2014.
  
  
  RESULTS
  In all, 63 cases were identified in 61 patients, mean (SD) age 71.1 (12.4) years; 58 were analyzed for local recurrence. Imiquimod was used as primary therapy in 22 of 63 (34.9%) and adjuvant therapy in 41 of 63 (65.1%) for mean duration of 11.7 (range 2-60) weeks. Fifty cases (86.2%) demonstrated clinical clearance at mean (SD) follow-up of 42.1 (27.4) months: 72.7% primary and 94.4% adjuvant at 39.7 (23.9) and 43.1 (28.9) months, respectively.
  
  
  CONCLUSIONS
  Retrospective cohort study and lack of standardized imiquimod application are limitations.
  
  
  CONCLUSIONS
  Imiquimod cream appears to be a viable option for primary or adjuvant treatment of LM in older patients who are poor surgical candidates.
authors: Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, California. Electronic address: sswetter@stanford.edu.
authors: Susan M
authors: SM
authors: Swetter
authors: Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, California.
authors: Frank W
authors: FW
authors: Chen
authors: Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, California.
authors: David D
authors: DD
authors: Kim
authors: Pathology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
authors: Barbara M
authors: BM
authors: Egbert
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage*; D000287:Administration, Topical; D000634:Aminoquinolines / Q000008:administration & dosage*; D002278:Carcinoma in Situ / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018327:Hutchinson's Melanotic Freckle / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology* / Q000503:physiopathology; D000077271:Imiquimod; D008297:Male; D008545:Melanoma / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000503:physiopathology; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D012189:Retrospective Studies; D018570:Risk Assessment; D063465:Skin Cream / Q000627:therapeutic use; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology* / Q000503:physiopathology; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000276:Adjuvants, Immunologic; D000634:Aminoquinolines; D000077271:Imiquimod
keywords: adjuvant therapy; imiquimod; inflammatory response; lentigo maligna; lentigo maligna melanoma; melanoma; melanoma in situ; primary therapy