Managing Melanoma In Situ

Toren, Kristen L.; Parlette, Eric C

doi:10.1016/j.sder.2010.10.002

Cited by 9 publications

(18 citation statements)

References 76 publications

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“…Toren and Parlette discusses various options for the management of MIS, including radiation, topical imiquimod, and cryotherapy. 16 In our study, all MIS were excised, either with conservative excision or in a minority of cases, employing Mohs surgery with frozen sections and immunostains. Clinical margins of 5mm were obtained on all lesions when allowed by anatomic constraints.…”

Section: Resultsmentioning

confidence: 99%

“…For larger lesions which had been sampled, margins were determined at the time of excision by dermoscopy, 24 and Woods lamp in some cases. Closure for some large lesions was delayed until pathology margins were determined, corresponding to “slow Mohs.” 16 Imiquimod was used adjunctively in 2% of patients, but was never used as a monotherapy. No recurrences were observed during the duration of the study, and no second MIS occurred during the study, but two recurrences were observed later.…”

Section: Resultsmentioning

confidence: 99%

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Melanoma in situ in a private practice setting 2005 through 2009: Location, lesion size, lack of concern

Stricklin

Stoecker

Malters

et al. 2012

Journal of the American Academy of Dermatology

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Background Studies have shown that the incidence of melanoma in situ (MIS) is increasing significantly. Objective This study analyzes selected clinical and demographic characteristics of MIS cases observed in private dermatology practices in the US. Methods This study collected 257 MIS cases from 4 private dermatology practices in the US from January 2005 through December 2009, recording age, gender, anatomic location, lesion size, patient-reported change in lesion and concern about lesion. Case totals for invasive melanoma during the same period were recorded. Results The data collected showed a higher incidence of MIS in sun-exposed areas of older patients, especially males. The median age of patients at the time of MIS detection was 69. The most common site for MIS was the head-neck region. The number of MIS cases collected exceeded the number of invasive malignant melanoma (MM) cases during the study period, with an observed ratio of 1.37:1. Limitations For 136 patients, data were collected retrospectively for lesion size, location, gender, and age. For these patients, patient-reported change in lesion and concern about lesion were not collected. Patients often did not consent to a full body examination, therefore, it is possible that MIS lesions may have been missed in double-clothed areas. Conclusion Careful attention to pigmented lesions, even lesions < 4mm, on sun-exposed areas, including scalp, trunk, and feet, will facilitate earlier diagnosis of MIS. As only 30.4% of males and 50% of females had concern about these lesions, it still falls to the dermatologist to discover MIS.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Melanoma in situ in a private practice setting 2005 through 2009: Location, lesion size, lack of concern

Stricklin

Stoecker

Malters

et al. 2012

Journal of the American Academy of Dermatology

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“…However, alternative treatment options for MIS are sometimes required for different reasons. Either the patient refuses excisional surgery or surgery is no longer recommended due to morbidity and/or cosmetic considerations [8]. Furthermore, older age, multiple previous surgical procedures, medical comorbidities may preclude from surgery.…”

Section: Discussionmentioning

confidence: 99%

“…This topical immunomodulator increases, after binding to the TLR’s, the endogenous production of interferon-alpha, exhibiting anticancer properties, interleukins (ILs) 6 and 12, as well as tumor necrosis factor alpha [7, 8]. Evidence-based medicine data on imiquimod and MIS are scarce.…”

Section: Discussionmentioning

confidence: 99%

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Recurrent In Situ Melanoma Successfully Treated with Ingenol Mebutate

Mansuy

Nikkels‐Tassoudji

Arrese³

et al. 2014

Dermatol Ther (Heidelb)

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BackgroundTreatment options for melanoma in situ (MIS) include imiquimod, radiation therapy, cryotherapy, excisional and Mohs surgery. Ingenol mebutate is a new topical treatment option recognized for actinic keratosis. Although in vitro effectiveness has been demonstrated on melanoma cell lines, its therapeutic potential for in vivo melanomas is unknown.Case ReportIn 2011, a 91-year-old woman presented a thick melanoma of her cheek. The lateral sections revealed persisting in situ melanoma, which were again excised. She presented for follow-up and a recurrent MIS was evidenced centered on the previous scar. She refused further surgery and ingenol mebutate (0.015% gel) was administered on three consecutive days. One month later, a complete clinical resolution was observed. Histology and immunohistology revealed no residual MIS.ConclusionIn this patient, ingenol mebutate was successful and well-tolerated as a topical, alternative therapy for MIS after failure of other treatment options.Electronic supplementary materialThe online version of this article (doi:10.1007/s13555-014-0051-4) contains supplementary material, which is available to authorized users.

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Microinvasive Melanoma

Quigley

Halpern

2013

Am J Clin Dermatol

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Surgical excision is the treatment of choice for primary melanomas and radiation therapy is the accepted alternative for the subset of lesions not amenable to surgery. With the recent rise in melanoma incidence, especially in the elderly, there are a growing number of cases that are neither amenable to surgery nor radiation therapy. In this article, we review pharmacotherapeutic approaches to microinvasive melanoma (invasive radial growth phase melanoma) that might be considered in such circumstances. There are no approved drugs for the treatment of primary melanoma and randomized controlled trials with 5 or more years of follow-up have not been performed. The limited studies and numerous case series in the literature on pharmacologic treatment of primary melanoma have focused on topical therapies. Accordingly, we provide a review of the potential pharmacotherapeutic agents in the treatment of microinvasive melanoma by extrapolating from the available limited literature on the use of fluorouracil, azelaic acid, retinoic acid derivatives, interferon (IFN)-α, imiquimod, and other agents for melanoma in situ, invasive melanoma, and epidermotropic melanoma metastases. Our review indicates that topical fluorouracil and tretinoin are not effective as single agents. The efficacy of azelaic acid, tazarotene, cidofovir, and intralesional IFN-α, interleukin-2, and IFN-β is undefined. Imiquimod is the most studied and promising agent; however, optimal dosage, therapeutic regimen, and survival rates are unknown. In the face of a growing demand for non-surgical treatments, formal clinical trials are needed to ascertain the role of pharmacotherapeutic agents in the treatment of microinvasive melanoma.

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Managing Melanoma In Situ

Cited by 9 publications

References 76 publications

Melanoma in situ in a private practice setting 2005 through 2009: Location, lesion size, lack of concern

Melanoma in situ in a private practice setting 2005 through 2009: Location, lesion size, lack of concern

Recurrent In Situ Melanoma Successfully Treated with Ingenol Mebutate

Microinvasive Melanoma

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