Treatment of recurrent mucosal melanoma of the oral cavity with topical imiquimod and pembrolizumab achieves complete histopathologic remission

Abstract

Mucosal melanomas constitute a subtype of melanoma with less effective treatments than cutaneous melanomas. We present a case of oral mucosal melanoma that recurred despite multiple resections and adjuvant temozolomide. Treatment with topical imiquimod combined with pembrolizumab achieved remission. A 56-year-old woman presented with a pigmented mass on her left anterior hard palate. Biopsy revealed malignant melanoma. The patient had resection with neck dissection with 3 months of adjuvant temozolomide due to positive margins. Malignant melanoma involving the hard palate recurred 1 year later requiring additional resection. Two years later, two additional pigmented lesions were found; further resections were deferred due to expected morbidity. Following 6 weeks of topical imiquimod treatment, the lesions shrunk significantly. Adjuvant pembrolizumab was added and complete histopathologic remission was observed in 6 months. The patient remained in remission for 4 years before new melanoma in situ was diagnosed, requiring five additional months of imiquimod. As of April 2021, there is no clinical evidence of melanoma. There are limited reports of oral melanoma treated with topical imiquimod. Here, imiquimod administered in combination with pembrolizumab achieved complete pathologic response.

Nanomaterials augmented bioeffects of ultrasound in cancer immunotherapy

“…Immunomodulators directly act in the immune system by increasing or decreasing the expression levels of certain proteins, enhancing the activity of the immune system and better fighting against cancers. They include thalidomine, lenalidominde, pomalidomide and imiquimod, in which thalidomine, lenalidominde and pomalidomide can prompt cells to release IL-2, exerting antitumor effects [ 73 ], imiquimod is applied to the skin as a cream that stimulates local immune responses against melanoma [ 74 ].…”

An Alternative Device for the Topical Treatment of Oral Cancer: Development and Ex-Vivo Evaluation of Imiquimod-Loaded Polysaccharides Formulations

“…Topical IMQ off-label uses are not limited to the skin but are also reported for oral mucosa disorders. In this last case, efficacy has been proven in the topical treatment of oral dysplasia [10], human papilloma virusrelated squamous cell carcinoma of the lip [11,12], mucosal melanoma [13,14], and oral squamous cell carcinoma [15]. In all the cases, the commercial cream Aldara ® was used.…”