Periocular Melanoma In Situ Treated With Imiquimod.
OBJECTIVE
To evaluate the efficacy of topical 5% imiquimod cream in the treatment of periocular melanoma in situ (lentigo maligna).


METHODS
Retrospective case series.


METHODS
There were 12 patients in this series, and the mean patient age was 77 years. The anatomical locations were the lower eyelid (n=5), upper and lower eyelid (n=4), lower eyelid including the eyelid margin (n=1), brow (n=1), and the medial canthus (n=1). Topical 5% imiquimod cream was used as a primary treatment (n=6) or as an adjunctive therapy following local excision (n=2), cryotherapy (n=2), or excisional biopsy with cryotherapy (n=2).


METHODS
Twelve patients with periocular melanoma in situ were treated with topical 5% imiquimod cream daily for a mean treatment period of 3.9 months. The clinical features of the patients and the responses to treatment were evaluated in a retrospective case series.


METHODS
Histologic clearance of atypical melanocytes.


RESULTS
Eleven patients achieved complete histologic clearance of atypical melanocytes on post-treatment biopsy. One patient could not tolerate local irritation from imiquimod and stopped in the first month of therapy with residual disease. The median follow-up time was 1.5 years. Side effects included redness (n=12), discomfort (n=6), swelling (n=4), ectropion (n=1), and conjunctival chemosis (n=1). The patients experienced no systemic side effects from the treatment.


CONCLUSIONS
Topical 5% imiquimod cream is an effective option as primary or adjunct therapy in the treatment of periocular melanoma in situ.
*Department of Ophthalmology and Visual Sciences, Yale School of Medicine, New Haven, Connecticut; †Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania; ‡Department of Dermatology, Yale School of Medicine, New Haven, Connecticut; and §Oculofacial Plastic Surgeons of Georgia, Atlanta, Georgia, U.S.A.
Maxwell D
MD
Elia
Sara E
SE
Lally
Allison M
AM
Hanlon
Jennifer N
JN
Choi
Juan J
JJ
Servat
Jerry A
JA
Shields
Carol L
CL
Shields
Flora
F
Levin
D000287:Administration, Topical; D000368:Aged; D000634:Aminoquinolines / Q000008:administration & dosage*; D000970:Antineoplastic Agents / Q000008:administration & dosage; D001706:Biopsy; D005142:Eyelid Neoplasms / Q000175:diagnosis / Q000188:drug therapy*; D005143:Eyelids / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D000077271:Imiquimod; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000188:drug therapy*; D012189:Retrospective Studies; D063465:Skin Cream / Q000008:administration & dosage; D012878:Skin Neoplasms; D016896:Treatment Outcome; D000096142:Cutaneous Malignant Melanoma
D000634:Aminoquinolines; D000970:Antineoplastic Agents; D000077271:Imiquimod