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Microinvasive Melanoma

Cutaneous Pharmacotherapeutic Approaches

  • Review Article
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Abstract

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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Acknowledgments

No funding was received to prepare this article. The authors have no conflicts of interest that are directly relevant to the contents of this article.

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  1. Dermatology Service, Memorial Sloan Kettering Cancer Center, 136 Mountain View Blvd, Basking Ridge, NJ, USA

    Elizabeth A. Quigley

  2. Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Allan C. Halpern

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  1. Elizabeth A. Quigley
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Correspondence to Elizabeth A. Quigley.

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Quigley, E.A., Halpern, A.C. Microinvasive Melanoma. Am J Clin Dermatol 14, 125–137 (2013). https://doi.org/10.1007/s40257-013-0012-1

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