Skip to main content
SpringerLink
Log in

Role of Topical Therapy: Imiquimod

  • Chapter
  • First Online:
Lentigo Maligna Melanoma

  • 665 Accesses

Abstract

The gold standard for treatment of lentigo maligna is complete surgical excision. Second-line non-surgical modalities include radiotherapy, laser therapy, and topical therapies. Evidence for the use of various topical agents, including tretinoin, azelaic acid, and 5-fluorouracil, is limited. The greatest evidence exists for imiquimod 5 % cream, which has been investigated in multiple case series and studies. Topical imiquimod appears to be effective in a subset of cases, but clinical response is unpredictable and guidelines for monitoring and follow-up remain to be established. As such, its role in the treatment of lentigo maligna remains controversial and additional studies with higher quality evidence are needed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Ahmed I, Berth-Jones J. Imiquimod: a novel treatment for lentigo maligna. Br J Dermatol. 2000;143(4):843–5.

    Article  CAS  PubMed  Google Scholar 

  2. Micali G, Lacarrubba F, Nasca MR, Schwartz RA. Topical pharmacotherapy for skin cancer: part I. Pharmacology. J Am Acad Dermatol. 2014;70(6):965.e1–12, quiz 977–8.

    Article  CAS  Google Scholar 

  3. Wolf IH, Kodama K, Cerroni L, Kerl H. Nature of inflammatory infiltrate in superficial cutaneous malignancies during topical imiquimod treatment. Am J Dermatopathol. 2007;29(3):237–41.

    Article  PubMed  Google Scholar 

  4. Rajpar SF, Marsden JR. Imiquimod in the treatment of lentigo maligna. Br J Dermatol. 2006;155(4):653–6.

    Article  CAS  PubMed  Google Scholar 

  5. Schon M, Schon MP. The antitumoral mode of action of imiquimod and other imidazoquinolines. Curr Med Chem. 2007;14(6):681–7.

    Article  PubMed  Google Scholar 

  6. Schon MP, Schon M. The small-molecule immune response modifier imiquimod – its mode of action and clinical use in the treatment of skin cancer. Expert Opin Ther Targets. 2006;10(1):69–76.

    Article  PubMed  Google Scholar 

  7. Schon MP, Schon M. Imiquimod: mode of action. Br J Dermatol. 2007;157 Suppl 2:8–13.

    Article  PubMed  Google Scholar 

  8. Michalopoulos P, Yawalkar N, Bronnimann M, Kappeler A, Braathen LR. Characterization of the cellular infiltrate during successful topical treatment of lentigo maligna with imiquimod. Br J Dermatol. 2004;151(4):903–6.

    Article  CAS  PubMed  Google Scholar 

  9. Bong AB, Bonnekoh B, Franke I, Schon M, Ulrich J, Gollnick H. Imiquimod, a topical immune response modifier, in the treatment of cutaneous metastases of malignant melanoma. Dermatology. 2002;205(2):135–8.

    Article  CAS  PubMed  Google Scholar 

  10. Cotter MA, McKenna JK, Bowen GM. Treatment of lentigo maligna with imiquimod before staged excision. Dermatol Surg. 2008;34(2):147–51.

    Article  CAS  PubMed  Google Scholar 

  11. Fleming CJ, Bryden AM, Evans A, Dawe RS, Ibbotson SH. A pilot study of treatment of lentigo maligna with 5 % imiquimod cream. Br J Dermatol. 2004;151(2):485–8.

    Article  CAS  PubMed  Google Scholar 

  12. Kirtschig G, van Meurs T, van Doorn R. Twelve-week treatment of lentigo maligna with imiquimod results in a high and sustained clearance rate. Acta Derm Venereol. 2015;95(1):83–5.

    Article  CAS  PubMed  Google Scholar 

  13. Ly L, Kelly JW, O'Keefe R, et al. Efficacy of imiquimod cream, 5 %, for lentigo maligna after complete excision: a study of 43 patients. Arch Dermatol. 2011;147(10):1191–5.

    Article  CAS  PubMed  Google Scholar 

  14. Naylor MF, Crowson N, Kuwahara R, et al. Treatment of lentigo maligna with topical imiquimod. Br J Dermatol. 2003;149 Suppl 66:66–70.

    Article  CAS  PubMed  Google Scholar 

  15. Powell AM, Robson AM, Russell-Jones R, Barlow RJ. Imiquimod and lentigo maligna: a search for prognostic features in a clinicopathological study with long-term follow-up. Br J Dermatol. 2009;160(5):994–8.

    Article  CAS  PubMed  Google Scholar 

  16. Powell AM, Russell-Jones R, Barlow RJ. Topical imiquimod immunotherapy in the management of lentigo maligna. Clin Exp Dermatol. 2004;29(1):15–21.

    Article  CAS  PubMed  Google Scholar 

  17. Spenny ML, Walford J, Werchniak AE, et al. Lentigo maligna (melanoma in situ) treated with imiquimod cream 5 %: 12 case reports. Cutis. 2007;79(2):149–52.

    PubMed  Google Scholar 

  18. Van Meurs T, Van Doorn R, Kirtschig G. Treatment of lentigo maligna with imiquimod cream: a long-term follow-up study of 10 patients. Dermatol Surg. 2010;36(6):853–8.

    Article  PubMed  Google Scholar 

  19. Wolf IH, Cerroni L, Kodama K, Kerl H. Treatment of lentigo maligna (melanoma in situ) with the immune response modifier imiquimod. Arch Dermatol. 2005;141(4):510–4.

    Article  CAS  PubMed  Google Scholar 

  20. Wong JG, Toole JW, Demers AA, Musto G, Wiseman MC. Topical 5 % imiquimod in the treatment of lentigo maligna. J Cutan Med Surg. 2012;16(4):245–9.

    Article  CAS  PubMed  Google Scholar 

  21. Mora AN, Karia PS, Nguyen BM. A quantitative systematic review of the efficacy of imiquimod monotherapy for lentigo maligna and an analysis of factors that affect tumor clearance. J Am Acad Dermatol. 2015;73(2):205–12.

    Article  CAS  PubMed  Google Scholar 

  22. Read T, Noonan C, David M, et al. A systematic review of non-surgical treatments for lentigo maligna. J Eur Acad Dermatol Venereol. 2015.

    Google Scholar 

  23. McLeod M, Choudhary S, Giannakakis G, Nouri K. Surgical treatments for lentigo maligna: a review. Dermatol Surg. 2011;37(9):1210–28.

    Article  CAS  PubMed  Google Scholar 

  24. Hou JL, Reed KB, Knudson RM, et al. Five-year outcomes of wide excision and Mohs micrographic surgery for primary lentigo maligna in an academic practice cohort. Dermatol Surg. 2015;41(2):211–8.

    Article  CAS  PubMed  Google Scholar 

  25. Gautschi M, Oberholzer PA, Baumgartner M, Gadaldi K, Yawalkar N, Hunger RE. Prognostic markers in lentigo maligna patients treated with imiquimod cream: a long-term follow-up study. J Am Acad Dermatol. 2016;74(1):81–7. e81.

    Article  CAS  PubMed  Google Scholar 

  26. Hyde MA, Hadley ML, Tristani-Firouzi P, Goldgar D, Bowen GM. A randomized trial of the off-label use of imiquimod, 5 %, cream with vs without tazarotene, 0.1 %, gel for the treatment of lentigo maligna, followed by conservative staged excisions. Arch Dermatol. 2012;148(5):592–6.

    Article  CAS  PubMed  Google Scholar 

  27. Swetter SM, Chen FW, Kim DD, Egbert BM. Imiquimod 5 % cream as primary or adjuvant therapy for melanoma in situ, lentigo maligna type. J Am Acad Dermatol. 2015;72(6):1047–53.

    Article  CAS  PubMed  Google Scholar 

  28. Paraskevas LR, Halpern AC, Marghoob AA. Utility of the Wood's light: five cases from a pigmented lesion clinic. Br J Dermatol. 2005;152(5):1039–44.

    Article  PubMed  Google Scholar 

  29. Schiffner R, Schiffner-Rohe J, Vogt T, et al. Improvement of early recognition of lentigo maligna using dermatoscopy. J Am Acad Dermatol. 2000;42(1 Pt 1):25–32.

    Article  CAS  PubMed  Google Scholar 

  30. de Troya-Martin M, Frieyro-Elicegui M, Funez Liebana R, Aguilar Bernier M, Fernandez-Canedo NI, Blazquez Sanchez N. Lentigo maligna managed with topical imiquimod and dermoscopy: report of two cases. Dermatol Surg. 2008;34(11):1561–6.

    PubMed  Google Scholar 

  31. Guitera P, Haydu LE, Menzies SW, et al. Surveillance for treatment failure of lentigo maligna with dermoscopy and in vivo confocal microscopy: new descriptors. Br J Dermatol. 2014;170(6):1305–12.

    Article  CAS  PubMed  Google Scholar 

  32. Alarcon I, Carrera C, Alos L, Palou J, Malvehy J, Puig S. In vivo reflectance confocal microscopy to monitor the response of lentigo maligna to imiquimod. J Am Acad Dermatol. 2014;71(1):49–55.

    Article  CAS  PubMed  Google Scholar 

  33. Alarcon I, Carrera C, Puig S, Malvehy J. Clinical usefulness of reflectance confocal microscopy in the management of facial lentigo maligna melanoma. Actas Dermosifiliogr. 2014;105(3):e13–7.

    Article  CAS  PubMed  Google Scholar 

  34. Guitera P, Moloney FJ, Menzies SW, et al. Improving management and patient care in lentigo maligna by mapping with in vivo confocal microscopy. JAMA Dermatol. 2013;149(6):692–8.

    Article  PubMed  Google Scholar 

  35. Guitera P, Pellacani G, Crotty KA, et al. The impact of in vivo reflectance confocal microscopy on the diagnostic accuracy of lentigo maligna and equivocal pigmented and nonpigmented macules of the face. J Invest Dermatol. 2010;130(8):2080–91.

    Article  CAS  PubMed  Google Scholar 

  36. Fisher GH, Lang PG. Treatment of melanoma in situ on sun-damaged skin with topical 5 % imiquimod cream complicated by the development of invasive disease. Arch Dermatol. 2003;139(7):945–7.

    Article  PubMed  Google Scholar 

  37. Coussens LM, Werb Z. Inflammation and cancer. Nature. 2002;420(6917):860–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Hazan C, Dusza SW, Delgado R, Busam KJ, Halpern AC, Nehal KS. Staged excision for lentigo maligna and lentigo maligna melanoma: a retrospective analysis of 117 cases. J Am Acad Dermatol. 2008;58(1):142–8.

    Article  PubMed  Google Scholar 

  39. Abdelmalek M, Loosemore MP, Hurt MA, Hruza G. Geometric staged excision for the treatment of lentigo maligna and lentigo maligna melanoma: a long-term experience with literature review. Arch Dermatol. 2012;148(5):599–604.

    Article  PubMed  Google Scholar 

  40. Iorizzo 3rd LJ, Chocron I, Lumbang W, Stasko T. Importance of vertical pathology of debulking specimens during Mohs micrographic surgery for lentigo maligna and melanoma in situ. Dermatol Surg. 2013;39(3 Pt 1):365–71.

    Article  CAS  PubMed  Google Scholar 

  41. Martires KJ, Capaldi L, Pattee SF, Maloney ME, Bordeaux JS. Failed treatment of amelanotic lentigo maligna with imiquimod followed by pigment production. Arch Dermatol. 2010;146(9):1047–8.

    Article  PubMed  Google Scholar 

  42. Kaidbey K, Owens M, Liberda M, Smith M. Safety studies of topical imiquimod 5 % cream on normal skin exposed to ultraviolet radiation. Toxicology. 2002;178(2):175–82.

    Article  CAS  PubMed  Google Scholar 

  43. Tran H, Moreno G, Shumack S. Imiquimod as a dermatological therapy. Expert Opin Pharmacother. 2004;5(2):427–38.

    Article  CAS  PubMed  Google Scholar 

  44. Tzellos T, Kyrgidis A, Mocellin S, Chan AW, Pilati P, Apalla Z. Interventions for melanoma in situ, including lentigo maligna. Cochrane Database Syst Rev. 2014;12, CD010308.

    Google Scholar 

  45. Kai AC, Richards T, Coleman A, Mallipeddi R, Barlow R, Craythorne EE. Five-year recurrence rate of lentigo maligna after treatment with imiquimod. Br J Dermatol. 2016;174(1):165–8.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 240 East 38th street, 11th floor, New York, NY, 10016, USA

    Elise Ng MD

  2. Department of Dermatology, NYU/Langone, 635 Madison Ave, 3rd Floor, New York, NY, 10022, USA

    Vicki Levine MD

Authors
  1. Elise Ng MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vicki Levine MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vicki Levine MD .

Editor information

Editors and Affiliations

  1. Attending Physician, Director of Mohs and Dermatologic Surgery Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, USA

    Kishwer S. Nehal

  2. Attending Pathologist Director of Dermatopathology Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, USA

    Klaus J. Busam

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Ng, E., Levine, V. (2017). Role of Topical Therapy: Imiquimod. In: Nehal, K., Busam, K. (eds) Lentigo Maligna Melanoma. Springer, Cham. https://doi.org/10.1007/978-3-319-43787-3_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-43787-3_11

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-43785-9

  • Online ISBN: 978-3-319-43787-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation