Imiquimod 5% cream in occlusion, for the treatment of lentigo maligna: A new scheme of short cycles and the need for clinical trials

Astorino, Stefano; Astorre, P.; Pasquini, Paola; Nunno, Donato Di; Pellegrini, F; Paolino, Giovanni

doi:10.1111/dth.12757

Cited by 9 publications

(10 citation statements)

References 6 publications

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“…1 The off-label use of IQ for lentigo maligna, cutaneous malignant melanoma metastases and superficial hemangiomas has also proved to be effective and safe. [2][3][4][5][6][7] Hemangiomas are benign tumors caused by an abnormal proliferation of immature endothelial cells (EC) with undefined vascular architecture. 8 These vascular tumors are more frequent in infants, and approximately 5-10% are dangerous because they do not involute and produce disfigurement, vision impairment and telangiectasia, among other serious problems.…”

Section: Backg Rou N Dmentioning

confidence: 99%

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Early redox homeostasis disruption contributes to the differential cytotoxicity of imiquimod on transformed and normal endothelial cells

Rocco

Botto

Muñoz

et al. 2021

Experimental Dermatology

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The off-label use of imiquimod (IQ) for hemangioma treatment has shown clinical benefits. We have previously reported a selective direct IQ-cytotoxic effect on transformed (H5V) vs. normal (1G11) endothelial cells (EC). In the present study, we investigated the mechanism underlying this selective cytotoxicity in terms of TLR7/8 receptor expression, NF-κB signalling and time-dependent modifications of oxidative stress parameters (ROS: reactive oxygen species, catalase and superoxide dismutase activities, GSH/GSSG and lipid peroxidation). TLR7/8 level was extremely low in both cell lines, and IQ did not upregulate TLR7/8 expression or activate NF-κB signalling. IQ significantly induced ROS in H5V after 2 h and strongly affected antioxidant defenses.After 12 h, enzyme activities were restored to baseline levels but a robust drop in GSH/GSSG persisted together with increased lipid peroxidation levels and a marked mitochondrial dysfunction. Although in normal IQ-treated EC some oxidative stress parameters were affected after 4 h, mitochondrial health and GSH/GSSG ratio remained notably unaffected after 12 h. Therefore, the early alterations (0-2 h) in transformed EC breached redox homeostasis as strongly as to enhance their susceptibility to IQ. This interesting facet of IQ as redox disruptor could broaden its therapeutic potential for other skin malignancies, alone or in adjuvant schemes.

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Section: Backg Rou N Dmentioning

confidence: 99%

“…It is commercially available as a cream for the treatment of several cutaneous disorders 1 . The off‐label use of IQ for lentigo maligna, cutaneous malignant melanoma metastases and superficial hemangiomas has also proved to be effective and safe 2–7 …”

Section: Introductionmentioning

confidence: 99%

Early redox homeostasis disruption contributes to the differential cytotoxicity of imiquimod on transformed and normal endothelial cells

Rocco

Botto

Muñoz

et al. 2021

Experimental Dermatology

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“…Both cumulative dose and treatment intensity affect tumor clearance. Indeed, treatment with more than 60 total applications or with more than five applications per week was associated with a higher likelihood of histopathological clearance 3,10 . However, very different treatment schedules have been used so far.…”

Section: Commentmentioning

confidence: 99%

“…Indeed, treatment with more than 60 total applications or with more than five applications per week was associated with a higher likelihood of histopathological clearance. 3,10 However, very different treatment schedules have been used so far. In addition, the clinical response to imiquimod 5% was closely related to development of an intense cutaneous reaction with an intense inflammation.…”

Section: Commentmentioning

confidence: 99%

Reflectance confocal microscopy and its role in the follow‐up of a topical treatment for lentigo maligna

et al. 2020

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Background In recent years, there has been an ongoing interest in topical treatment for lentigo maligna (LM) as imiquimod 5% cream owing to the localization of this tumor and the advanced age of patients; however, the efficacy of imiquimod 5% cream is controversial, and the rate of local relapses is about 25–53%. Reflectance confocal microscopy (RCM) is a noninvasive diagnostic tool useful not only for diagnostic purpose but also for monitoring the response to the local treatment of LM. Our aim was to demonstrate the role of RCM in the follow‐up of a topical treatment with imiquimod 5% cream in clinical practice. Methods We report three patients with histopathologically confirmed LM who were not candidates for surgery and were successfully treated with imiquimod 5% cream. In such patients, dermatoscopic images and reflectance confocal microscopy were useful to evaluate treatment response and to verify long‐term clinical benefits during the follow‐up visits. Results No relapses were observed in our patients 18 months after the end of treatment; although, continuous follow‐up visits are needed in these patients. Conclusions In the case series presented herein, we highlight the importance of RCM as a noninvasive tool to monitor the efficacy of imiquimod to treat LM during and after treatment. Detailed confocal images of two of our patients allowed us to establish the persistence of atypical cells and to continue treatment, although clinical and dermatoscopic examinations showed “apparent complete remission” after the first cycle of therapy.

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“…This shift in healthcare delivery has allowed patients to practice social distancing and avoid in-person visits, but there are many limitations in terms of medical care, especially with skin cancer treatments [6][7][8]. Although melanoma-in-situ (MIS) is typically treated by surgical excision, reports have shown that topical imiquimod, 5-fluorouracil, and certain retinoids used as a mono or dual therapy have been effective treatments for melanoma and MIS [9][10][11][12][13][14]. Here we present the case of a patient who had two effective treatments of MISs in a pandemic setting with a combination of topical imiquimod 5% cream, 5-fluorouracil 2% solution, and tretinoin 0.1% cream.…”

Section: Introductionmentioning

confidence: 99%

Treating Melanoma in Situ During a Pandemic with Telemedicine and a Combination of Imiquimod, 5-Fluorouracil, and Tretinoin

Nahm

Gwillim

Badiavas

et al. 2021

Dermatol Ther (Heidelb)

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The recent coronavirus disease 2019 (COVID-19) pandemic has created a quandary for the physician in terms of evaluating and treating cutaneous skin cancers, particularly melanomas. At the onset of the pandemic, many planned medical and surgical visits for skin cancers were postponed. Physicians and patients have had to balance the risk of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with that of worsening morbidity and mortality due to delays in skin cancer treatments. We present a male patient who had two melanoma-in-situs (MISs) that were treated during the COVID-19 pandemic with a combination of topical imiquimod 5% cream, 5-fluorouracil 2% solution, and tretinoin 0.1% cream. The successful treatments occurred without in-person visits and with the aid of telemedicine. Although surgery is the standard for the treatment of melanoma in situ, this case demonstrates an effective viable treatment modality for MIS during a pandemic situation.

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Imiquimod 5% cream in occlusion, for the treatment of lentigo maligna: A new scheme of short cycles and the need for clinical trials

Abstract: FIGURE 2 The scheme reported above has been performed for a total of 5 weeks, of which three of treatment and two of without treatment stop

Cited by 9 publications

References 6 publications

Early redox homeostasis disruption contributes to the differential cytotoxicity of imiquimod on transformed and normal endothelial cells

Early redox homeostasis disruption contributes to the differential cytotoxicity of imiquimod on transformed and normal endothelial cells

Reflectance confocal microscopy and its role in the follow‐up of a topical treatment for lentigo maligna

Treating Melanoma in Situ During a Pandemic with Telemedicine and a Combination of Imiquimod, 5-Fluorouracil, and Tretinoin

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