Ingenol Mebutate for Lentigo Maligna: A Case Report

Area of Science:

• Dermatology
• Oncology
• Medical Research

Background:

• Lentigo maligna (LM) is a type of melanoma in situ commonly affecting elderly individuals on sun-damaged skin, particularly the head and neck.
• Current treatments include surgery, cryotherapy, radiotherapy, and topical imiquimod, with surgical excision being the standard due to its low recurrence rate.
• Ingenol mebutate, a topical treatment, has recently shown promise for melanoma in situ.

Observation:

• This case report investigates ingenol mebutate as a potential treatment for LM in a difficult-to-treat location.
• The patient had previously failed treatment with topical imiquimod.
• The study aimed to assess the efficacy and tolerability of ingenol mebutate gel 0.015% applied once daily for three consecutive days.

Findings:

• Despite visible inflammation during treatment, no macroscopic clearance of the lentigo maligna lesion was observed.
• Initial follow-up with reflectance confocal microscopy (RCM) at 6 weeks showed no signs of LM.
• However, a recurrence of the lesion was confirmed at 12 weeks via RCM and biopsy.

Implications:

• Ingenol mebutate may not be a universally effective treatment for all cases of lentigo maligna.
• The findings suggest that ingenol mebutate's efficacy is variable and may not be suitable as a standard treatment for LM.
• Further studies are required to identify patient or lesion characteristics that predict successful outcomes with ingenol mebutate therapy.