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Clinical and histologic features associated with lentigo maligna clearance after imiquimod treatment
R Kwak1, C Joyce2, A E Werchniak3
1Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Background:
Imiquimod cream may be used as a non-surgical treatment for lentigo maligna or as adjuvant therapy following excision to decrease the risk of recurrence.
Objectives:
To evaluate histologic and clinical factors associated with clinical clearance of lentigo maligna treated with imiquimod.
Methods:
We performed a retrospective review of all patients diagnosed with lentigo maligna and treated with imiquimod between 1997 and 2019 at our academic institution.
Results:
We observed clinical clearance in 93% (66/71) of participants who received adjuvant imiquimod following surgery and 79% (19/24) in the primary non-surgical treatment group over a median of 38 months of follow-up. In the adjuvant therapy group, positive surgical margins were associated with a decreased rate of clinical clearance when compared to cases with close (<1 mm) margins or background melanocytic dysplasia (83.3 vs. 100%, p = .01). The presence of an inflammatory response during treatment was associated with increased clearance (94.1 vs. 66.7%, p = .02).
Conclusions:
Adjuvant imiquimod treatment may decrease LM recurrence rates in cases with background melanocytic dysplasia or close margins. LM cases with positive surgical margins need close clinical follow-up given higher recurrence rates.
