VIENNA — Imiquimod appears to be an excellent off-label treatment option in selected patients with lentigo maligna, Ingrid H. Wolf, M.D., said at the annual meeting of the European Society for Dermatological Research.
She reported on five patients with biopsy-proven lentigo maligna on the face and/or shoulder who underwent a course of imiquimod therapy because they had contraindications for surgery, the standard first-line treatment. The participants self-applied 5% imiquimod cream once daily for 5–13 weeks.
All five patients experienced a complete clinical and histopathologic response. They have now been followed for 7–22 months with no evidence of recurrence, said Dr. Wolf of the University of Graz (Austria).
The only significant side effect was the occurrence of erythema and erosions at the treatment site in all of the patients 2–4 weeks after the start of therapy.
Immunohistologic assessment performed at several time points during treatment suggested the topical agent induced a cytotoxic T-cell-mediated immune response, she continued.
The predominant finding was an inflammatory cell infiltrate comprised of helper T cells that were mixed in with monocytes, macrophages, and cytotoxic cells.
Situations in which it would be appropriate for dermatologists to consider turning to imiquimod for the treatment of patients with lentigo maligna include large lesions, advanced patient age, ill-defined lesional margins, a cosmetically precarious anatomic location, and comorbid systemic illness that increases surgical risk, Dr. Wolf said.