Powell AM, Robson AM, Russell-Jones R et al.
Guy’s and St Thomas’ NHS Trust, London, UK.
Br J Dermatol 2009;160:994–8.
Editor’s note: Current guidance for the management of lentigo maligna (LM) suggests surgical excision with 0.5 cm margins. This can be challenging, as patients are often elderly and lesions are often facial and can be large with extensive subclinical spread. Topical therapy with imiquimod has been suggested as a possible therapeutic option. The current study by Powell et al. is a follow-up to their previoussmaller study (
Clin Exp Dermatol 2004;29:15–21), examining retrospective data on 48 patients (17 males, 31 females; age range 44–90 years) with facial LM who were treated with imiquimod 5%. Overall, 37 patients (79%) responded to imiquimod treatment, with no clinical or histological evidence of residual LM at 4–6 months after therapy (or on subsequent long-term follow-up). Two further patients showed partial improvement, with a possible reduction in the extent of the lesion. Another patient was found to have an invasive melanoma (Breslow thickness 0.46 mm). The 11 patients who did not respond were referred for surgical excision. There was no evidence of recurrent disease in the imiquimod responsive group on follow-up (mean 48 months). In addition, an inflammatory response to imiquimod was a strong predictor of therapeutic benefit; 31 of the 37 responders reported an inflammatory reaction. Biopsy specimens were examined but no histological prognostic indicators were identified.