Treating lentigo maligna with imiquimod

The gold standard of treatment for lentigo maligna is surgery, but this can result in significant scarring

Lentigo maligna: imiquimod treatment confers long-term benefit (Image: Dr P Marazzi/SPL)
Lentigo maligna: imiquimod treatment confers long-term benefit (Image: Dr P Marazzi/SPL)

Imiquimod has been used with good cosmetic results, but there has been little published data on recurrence. 

This study aimed to assess the five-year recurrence rate after imiquimod therapy. A group of 40 patients treated with imiquimod during 2002 and 2007 were assessed. Previous treatments included cryotherapy, incomplete surgical excision and/or radiotherapy. 

All applied imiquimod three times a week for six weeks, resulting in inflammation in 25 out of 40. The remainder (15 of the 40) continued with treatment five times a week for a further four weeks; all experienced inflammation. 

Overall, after treatment, 27 patients were histologically clear and were invited to attend for review. Of these, 18 participated in the study. The recurrence rate in this group was 0%. The mean time between patients receiving imiquimod therapy and review was seven years and five months, with the range from five years and nine months to 10 years and one month.

The authors conclude that patients who initially benefit from using imiquimod and have histologically confirmed clearance experience sustained benefit long term. Although surgery is likely to remain the gold standard, imiquimod may avoid large surgical resections in cosmetically sensitive sites.

Kai AC, Richards T, Coleman A et al. Br J Dermatol 2016; 174: 165-8

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