Treatment of lentigo maligna with tazarotene 0.1% gel

Abstract

We report 2 elderly patients with facial lentigo maligna who experienced complete regression, both clinically and histopathologically, after once-daily topical treatment with tazarotene 0.1% gel for 6 to 8 months. After a follow-up period of 18 and 30 months, no recurrence was observed. We believe that tazarotene might be considered as an alternative medical approach in selected patients with lentigo maligna. (J Am Acad Dermatol 2004;50:101-3.) L entigo maligna (LM) is considered an in situ melanoma, clinically appearing as a patch with variegate color and irregular margins, located on sun-exposed areas of middle-aged or elderly patients. It is characterized by a slow radial growth phase, followed in some cases and after several months to years, by development of invasive melanoma. The risk for invasive LM increases in lesions larger than 1.5 cm in diameter. The treatments of choice for LM are surgical excision and Mohs micrographic operation, both of which provide a high cure rate and a low recurrence rate. 1 Other therapeutic approaches include cryotherapy; curettage and electrodessication; argon, carbon-dioxide, or Q-switched lasers; and radiotherapy. 1-5 A medical approach such as intralesional interferon alfa, topical azelaic acid, and imiquimod can be effective in older patients with compromised general conditions and in lesions that are difficult to excise because of their extension or location. [6][7][8] Tazarotene is an acetylenic retinoid highly selective for the ␤ and ␥ subtypes of retinoid acid receptors, whereas it does not bind to the retinoid X receptors. 9 Soon after its introduction for topical treatment of mild to moderate psoriasis, tazarotene 0.1% gel has been used to treat a variety of cutaneous diseases including congenital ichthyosis, Darier's disease, and basal cell carcinoma with good clinical response. [10][11][12] We report 2 patients with LM successfully treated with tazarotene 0.1% gel. CASE REPORTS Case 1An 80-year-old woman was examined for an asymptomatic, 3.8-ϫ 3-cm patch with variegate color ranging from pink to brown and black, located on the left zygomatic region (Fig 1, A). The lesion had been present for 10 years and previously treated with cryosurgery, and electrodessication and curettage. Dermoscopic analysis showed features highly suggestive of LM such as asymmetric pigmented follicular openings, rhomboidal structures, irregular pigmentation, and slate-gray dots/globules. Histopathologic examination of a 5-mm punch biopsy specimen, taken from the most pigmented area of the lesion, revealed atypical melanocytes, isolated and in small nests, located in the basal layer of the epidermis. Elastotic changes were present in the dermis. On the basis of the patient's refusal to undergo surgical excision, we proposed a topical treatment with once-daily tazarotene 0.1% gel. The patient was informed of the investigative nature of the treatment and written informed consent was obtained. Complete regression, clinically corresponding to disappearance of the lesion and dermoscopically...

The importance of surgical margins in melanoma

“…Although surgical resection is the standard of care, several topical pharmacologic therapies have been used for the treatment of melanoma in situ with varying success rates. These include 5‐fluorouracil, azelaic acid, retinoic acid derivatives, interferon (IFN)‐α, and imiquimod . Of particular interest is imiquimod, an immune response modifier that causes a localized immune response at targeted sites by activating Toll‐like receptor 7 .…”

One-year follow-up of a lentigo maligna: first dermoscopic signs of growth

“…We have previously described dermoscopic features that could represent first signs of growth of lentigo maligna: dark‐brown or black asymmetrical pigmented follicular openings, dark‐brown or black rhomboidal structures around follicles, slate‐grey dots and slate‐grey globules 1 . Knowledge of these dermoscopic features is important for detection of lentigo maligna, especially since the introduction of new treatment methods such as topical imiquimod or tazarotene, especially for large tumours, in poor surgical candidates or in younger patients to avoid scarring 2–4 . Although the first data were promising, regular follow‐up of treated lesions is recommended following both topical treatments (due to lack of long‐term follow‐up data) and following surgery (due to possible technical problems in determining clear surgical margins) 5 .…”

“…1 Knowledge of these dermoscopic features is important for detection of lentigo maligna, especially since the introduction of new treatment methods such as topical imiquimod or tazarotene, especially for large tumours, in poor surgical candidates or in younger patients to avoid scarring. [2][3][4] Although the first data were promising, regular followup of treated lesions is recommended following both topical treatments (due to lack of long-term follow-up data) and following surgery (due to possible technical problems in determining clear surgical margins). 5 Therefore, it is important to be able to recognize the first signs of new and recurrent lentigo maligna.…”

Lentigo Maligna Treatment—An Update

“…Tazarotene is a retinoid used for different inflammatory skin conditions like psoriasis, Darier's disease, congenital ichthyosis. It has also been used in patients with basal cell carcinoma, with a good clinical response [66]. Small case series reported the use of this topical treatment in LM alone or in combination with imiquimod.…”