Imiquimod in lentigo maligna

Topical imiquimod before conservative excision of lentigo maligna (LM) may decrease surgical defect size, but should not be used as an alternative to surgery, researchers have said

Lentigo maligna: researchers studied use of topical imiquimod (Photograph: Dr Richard Turner)
Lentigo maligna: researchers studied use of topical imiquimod (Photograph: Dr Richard Turner)

Clinicians looked at 90 patients with 91 biopsy-confirmed LM who were randomised into two groups. One group (46 patients with 47 LM) received imiquimod 5% cream five days per week for three months, with 27 complete responses.
The other group of 44 patients with 44 LM received imiquimod and tazarotene 1% gel two days per week for three months, with 29 complete responses.

The patients were told to treat an area extending one inch beyond the outlined tumour margins and were monitored monthly for signs of inflammation and tumour regrowth. Afterwards, all patients had staged excision and frozen section analysis to confirm the negative margins.

The difference between the results of the two groups did not meet statistical significance (p =.17). There were no recurrences to date after a follow-up of 42 months. There was residual LM on staged excision in both groups, with 36% of lesions (15 of 42) in the imiquimod group and 22% of lesions (eight of 37) in the imiquimod plus tazarotene group.

The authors recommend topical imiquimod followed by conservative staged excision using 2mm margins.
Hyde MA, Hadley ML, Tristani-Firouzi P et al. Arch Dermatol 2012; 148(5): 592-6

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