Lentigo Maligna—Challenges, Observations, Imiquimod, Confocal Microscopy, and Personalized Treatment

Abstract

The word melanoma imparts considerable fear and concern in patients. Fortunately, for patients with the lentigo maligna (LM) subtype of melanoma in situ, there is overall good prognosis. The challenge of LM, however, is that it has the highest rate of local recurrence (approximately 20%) of all melanoma subtypes when treated by standard surgical excision alone, 1 owing to frequent, unpredictable, subclinical extension. To reduce this risk, the use of Mohs surgery or staged excision has consistently demonstrated lower recurrence rates of 0.3% to 2.2% yet requires larger surgical margins for histological clearance than other in situ melanoma subtypes. 2,3 Moyer et al 3 also demonstrated that with increas-

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

“…Previous retrospective studies have documented a clinical response rate of 73% after a 40-month follow-up (Fosko et al, 2018), while a systematic review of mainly retrospective studies showed a 77% histological clearance rate (Tio et al, 2017).…”

“…The main challenge of LM is its highest rate of local recurrence (Fosko, Navarrete-Dechent, & Nehal, 2018). The main challenge of LM is its highest rate of local recurrence (Fosko, Navarrete-Dechent, & Nehal, 2018).…”

“…(Fosko et al, 2018)In this spectrum, imiquimod 5% cream in occlusion, may be a valid therapeutic alternative, although only palliative. (Fosko et al, 2018)In this spectrum, imiquimod 5% cream in occlusion, may be a valid therapeutic alternative, although only palliative.…”

“…monly arises on the head and neck in elderly patients. The main challenge of LM is its highest rate of local recurrence (Fosko, Navarrete-Dechent, & Nehal, 2018). In this regard, Mohs surgery has consistently demonstrated lower recurrence rates of 0.3-2.2% (Kunishige, Brodland, & Zitelli, 2012;Moyer et al, 2017).…”

“…Indeed, the head and neck region, for anatomic purposes, are typically associated with higher recurrences and/or aesthetic impairment (Fosko et al, 2018). Finally, the age is a further factor, as elderly patients with LM may have several comorbidities, which could be important contraindications for the surgery.…”