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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.
Insights
Imiquimod cream shows high clearance rates for lentigo maligna (LM), especially as adjuvant therapy post-surgery. Positive margins indicate higher recurrence risk, necessitating close follow-up for non-surgical LM treatment.
Area of Science:
- Dermatology
- Oncology
- Pharmacology
Background:
- Lentigo maligna (LM) is a challenging skin condition.
- Imiquimod cream offers a non-surgical treatment option for LM.
- Adjuvant imiquimod therapy can reduce LM recurrence after surgical excision.
Purpose of the Study:
- To evaluate factors influencing clinical clearance of LM treated with imiquimod.
- To assess the efficacy of imiquimod in non-surgical and adjuvant settings for LM.
- To identify predictors of recurrence in LM patients treated with imiquimod.
Main Methods:
- Retrospective review of LM patients treated with imiquimod (1997-2019).
- Analysis of clinical and histologic factors associated with treatment outcomes.
- Comparison of clearance rates between non-surgical and adjuvant imiquimod therapy groups.
Main Results:
- High clinical clearance rates observed: 93% with adjuvant imiquimod and 79% with non-surgical treatment.
- Positive surgical margins correlated with decreased clearance in the adjuvant group (83.3% vs. 100%).
- Inflammatory response during treatment was associated with increased clearance (94.1% vs. 66.7%).
Conclusions:
- Adjuvant imiquimod may lower LM recurrence, particularly with close margins or melanocytic dysplasia.
- LM cases with positive surgical margins require vigilant clinical monitoring due to elevated recurrence risk.
- Imiquimod demonstrates potential in managing LM, with varying outcomes based on surgical margins and inflammatory response.
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.
