Imiquimod 5% cream as primary or adjuvant therapy for melanoma in situ, lentigo maligna type

A two-stage treatment of lentigo maligna using ablative laser therapy followed by imiquimod: excellent cosmesis, but frequent recurrences on the nose

“…Because the epidermis and reticular dermis are removed by laser ablation, deeper penetration of imiquimod is enabled and it is delivered closer to its target cell (the dermal dendritic cell). We observed a strong inflammatory response in 100% of our patients, in contrast to imiquimod monotherapy where there are also nonresponders (14–31%) . The inflammatory reaction and adverse effects of imiquimod account for much of the perceived treatment‐related discomfort in our cohort.…”

Effect of topical imiquimod as primary treatment for lentigo maligna: the LIMIT-1 study

“…The use of topical imiquimod as a nonsurgical treatment for LM has increased following an initial case report in 2000 of disease control for 9 months after treatment for 7 months . Treatment duration is not defined, but 12 weeks is widely used; any benefit of longer treatment is unclear. An effect against LM has been confirmed in subsequent case reports and small uncontrolled trials, and in a systematic review, with response rates of 77–90%.…”

“…One small study used complete surgical excision following imiquimod treatment, and reported complete response in four of six patients recruited . A recent retrospective series reported recurrence of LM following imiquimod alone in six of 22 patients vs. two of 36 having surgery plus imiquimod with a mean follow‐up of around 40 months …”

Challenges of treating melanoma in situ , lentigo maligna type: is pathological clearance the gold standard?

“…The LIMIT‐1 study showed lower rates of imiquimod response for LM than those previously reported, including a 2015 systematic review by Mora et al . of 45 studies between 2000 and 2014 of 347 LMs, most (73·8%) of which were treated primarily with imiquimod and not in the adjuvant setting (following attempted resection) or for local recurrence.…”

“…Other studies assessing the use of imiquimod for primary treatment of LM support that ongoing treatment until cCR may be necessary to eradicate tumour cells . Thus, a pre‐defined stop‐point of 12 weeks may underestimate treatment efficacy, in the event that a longer course of therapy is needed.…”