2015, Number 1
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Med Cutan Iber Lat Am 2015; 43 (1)
Study 2000-2012 lentigo maligna treated with topical imiquimod 5%
García OOA, Molina FE, Vera IME, Honorato GS, Mollejo VM, Schöendorff OC
Language: Spanish
References: 14
Page: 36-40
PDF size: 191.98 Kb.
ABSTRACT
Introduction: The treatment of lentigo maligna (LM) in many cases is complex. The treatment of choice is surgery, but when this is not possible, we have to use alternative treatments. Topical imiquimod 5% has been used in recent years with mixed results and is currently controversial. Our objective is to describe the evolution of patients diagnosed with LM in our hospital and treated with imiquimod cream 5%, for a long period of follow-up.
Observations, material and methods: All patients diagnosed with LM from 2000 through 2012 were collected and those treated with imiquimod were included in the study. The characteristics of the patients, reason for use of imiquimod, prior treatment received, used procedure, initial response, time of monitoring and presence of recurrence were studied during the follow up.
Results: A total of 21 of the 23 patients completed the treatment. 76% responded to treatment with topical imiquimod. All patients who responded had a significant inflammatory skin reaction. The mean follow-up of patients was five years. During this time only one recurrence was recorded and probably is a patient misclassified as responder.
Conclusions: Imiquimod should not be a treatment for LM. In selected patients, where surgery is not possible, imiquimod treatment could be tested, and if we see a significant initial inflammatory response to treatment and the absence of clinical data of LM at the end of it, is likely to get long-term remission.
REFERENCES
Heenan P, Spatz A, Cerio R, Bastian BC. Lentigo maligna. In: Leboit PE, Burg G, Weedon D, Sarasin A et al. Pathology and genetics of skin tumours. Lyon, IARCPress; 2006, pp. 70-72
Erickson C, Miller SJ. Treatment options in melanoma in situ: topical and radiation therapy, excision and Mohs surgery. Int J Dermatol. 2010; 49: 482-491.
Nagore E, Oliver V, Botella-Estrada R, Moreno-Picot S, Guillén C, Fortea JM. Clinicopathological analysis of 1,571 cutaneous malignant melanomas in Valencia, Spain: factors related to tumour thickness. Acta Derm Venereol. 2006; 86: 50-56.
Nagore E, Botella-Estrada R. Imiquimod para el tratamiento del lentigo maligno. Actas Dermosifiliogr. 2011; 102 (8): 559-562.
Farshad A, Burg G, Panizzon R, Dummer R. A retrospective study of 150 patients with lentigo maligna and lentigo maligna melanoma and the efficacy of radiotherapy using Grenz or soft X-rays. Br J Dermatol. 2002; 146: 1042-1046.
Samaniego E, Redondo P. Lentigo maligno. Actas Dermosifiliogr. 2012. Artículo en prensa. http://dx.doi.org/10.1016/j.ad.2012.05.006
Kang HY, Park TJ, Jin SH. Imiquimod, a Toll-like receptor 7 agonist, inhibits melanogenesis and proliferation of human melanocytes. J Invest Dermatol. 2009; 129: 243-246.
Michalopoulos P, Yawalkar N, Brönnimann M, Kappeler A, Braathen LR. Characterization of the celular infiltrate during successful topical treatment of lentigo maligna with imiquimod. Br J Dermatol. 2004; 151: 903-906.
Narayan R, Nguyen H, Bentow JJ et al. Immunomodulation by imiquimod in patients with high-risk primary melanoma. J Invest Dermatol. 2012; 132: 163-169.
Ahmed I, Berth-Jones J. Imiquimod: a novel treatment for lentigo maligna. Br J Dermatol. 2000; 143: 843-845.
Martín T, Ojeda A, Martínez S, Vera A. Lentigo maligno tratado con crema de imiquimod 5%. Actas Dermosifilogr. 2005; 96 (10): 700-702.
Cotter MA, McKenna JK, Bowen GM. Treatment of lentigo maligna with imiquimod before staged excision. Dermatol Surg. 2008; 34: 147-151.
Woodmansee CS, McCall MW. Recurrence of lentigo maligna and development of invasive melanoma after treatment of lentigo maligna with imiquimod. Dermatol Surg. 2009; 35: 1286-1289.