title: Melanoma in Situ Treated with Topical Imiquimod for Management of Persistently Positive Margins: A Review of Treatment Methods.
abstract: BACKGROUND
  Imiquimod is a topical cream approved by the US Food and Drug Administration for treatment of superficial basal cell carcinoma, actinic keratosis, and genital-perianal warts. Its successful use in patients with persistently positive margins of melanoma in situ (MIS) after surgical excision has been previously reported.
  
  
  METHODS
  A 75-year-old female presented with a primary melanoma that was removed through an elliptical excision with 1 cm margins. Pathology revealed 3 involved margins with residual MIS without an invasive component. After a second operation removed an additional 1 cm margin, pathology revealed 2 positive margins with residual MIS. Rather than undergoing a third excision, the patient decided to pursue a nonsurgical approach with topical imiquimod, and at the 4-month follow-up examination, the incision was completely healed with no clinical evidence of tumor recurrence.
  
  
  CONCLUSIONS
  A nonsurgical approach with 5% topical imiquimod cream applied along the incision was utilized. In specific patient populations, the use of imiquimod is a reasonable alternative approach for the management of persistently positive MIS margins. Long-term follow-up is necessary to assess for evidence of recurrence and the ultimate success of this nonsurgical approach.
authors.affiliation: General & Oncology Surgery Departments, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Fan
authors.affiliation: Department of Surgery, Advocate Cancer Institute, Advocate Christ Medical Center, Oak Lawn, IL.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Cohen
authors.affiliation: Department of Pathology, Advocate Lutheran General Hospital, Park Ridge, IL.
authors.forename: Becky
authors.initials: B
authors.lastname: John
authors.affiliation: Department of Surgery, Advocate Cancer Institute, Advocate Christ Medical Center, Oak Lawn, IL.
authors.forename: Adam I
authors.initials: AI
authors.lastname: Riker
keywords: Administration–topical; imiquimod; melanoma