Original articleIn vivo reflectance confocal microscopy to monitor the response of lentigo maligna to imiquimod
Section snippets
Methods
A prospective study of 20 patients referred for treatment of LM was conducted at the Melanoma Unit of Hospital Clinic in Barcelona, between June 2007 and June 2011. All lesions were histologically confirmed facial LM, not amenable to surgical treatment or radiation therapy. Immunocompromised patients and those with clinical and histologic evidence of LM melanoma were excluded. Informed consent for acquiring the images, taking sample biopsy specimens, and treatment was obtained after discussing
Results
The study comprised a total of 20 patients (14 women and 6 men) aged from 33 to 90 years (median 76.5) recruited at the Melanoma Unit of Hospital Clinic in Barcelona, between May 2008 and June 2011. Most tumors were located on the face and the anatomic location of the lesions included the buccal region (14 patients), nasal region (3 patients), scalp (1 patient), forehead (1 patient), and periorbital region (1 patient). Although the clinical diameter of the lesions ranged from 0.8 to 4 cm, the
Discussion
According to a review of the literature regarding treatment of LM with topical imiquimod,4 the studies showing the highest clearance rates for imiquimod (up to 91%) were those where the evaluation of tumor clearance was based on clinical evaluation20 or after treatment biopsies, with the risk of overvaluing the response. The efficacy rates reported by studies performing standard wide local excision22, 23 or staged excision17 after imiquimod treatment were lower: 53%,22 68%,23 and 75%17 of
References (36)
- et al.
Increasing incidence of lentigo maligna melanoma subtypes: northern California and national trends 1990-2000
J Invest Dermatol
(2005) Lentigo maligna and lentigo maligna melanoma
J Am Acad Dermatol
(1995)- et al.
Histologic evaluation of lentigo maligna with permanent sections: implications regarding current guidelines
J Am Acad Dermatol
(2002) - et al.
Guidelines of care for the management of primary cutaneous melanoma
J Am Acad Dermatol
(2011) - et al.
Surgical margins for melanoma in situ
J Am Acad Dermatol
(2012) - et al.
Imiquimod, a toll-like receptor 7 agonist, inhibits melanogenesis and proliferation of human melanocytes
J Invest Dermatol
(2009) - et al.
In vivo confocal scanning laser microscopy of human skin II: advances in instrumentation and comparison with histology
J Invest Dermatol
(1999) - et al.
In vivo confocal scanning laser microscopy of human skin: melanin provides strong contrast
J Invest Dermatol
(1995) - et al.
The impact of in vivo reflectance confocal microscopy for the diagnostic accuracy of melanoma and equivocal melanocytic lesions
J Invest Dermatol
(2007) - et al.
In vivo reflectance confocal microscopy enhances secondary evaluation of melanocytic lesions
J Invest Dermatol
(2009)
Confocal features of equivocal facial lesions on severely sun-damaged skin: four case studies with dermatoscopic, confocal, and histopathologic correlation
J Am Acad Dermatol
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
The biologic forms of malignant melanoma
Hum Pathol
A follow-up study to investigate the efficacy of initial treatment of lentigo maligna with surgical excision
Br J Plast Surg
Melanoma in situ treated successfully using imiquimod after nonclearance with surgery: review of the literature
Dermatol Surg
Treatment options in melanoma in situ: topical and radiation therapy, excision and Mohs surgery
Int J Dermatol
National Institutes of Health consensus development conference statement on diagnosis and treatment of early melanoma, January 27-29, 1992
Am J Dermatopathol
Treatment of cutaneous melanoma of the face by Mohs micrographic surgery
J Cutan Med Surg
Cited by (0)
The research at the Melanoma Unit in Barcelona is partially funded by grants 09/1393 and 12/00840 from Fondo de Investigaciones Sanitarias, Spain; by the Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Raras of the Instituto de Salud Carlos III, Spain, cofunded by “Fondo Europeo de Desarrollo Regional, Unión Europea, Una manera de hacer Europa”; by the Agència de Gestió d'Ajuts Universitaris i de Recerca (AGAUR) 2009 SGR 1337 of the Catalan Government, Spain; by the European Commission under the Sixth Framework Programme, Contract no. LSHC-CT-2006-018702 (GenoMEL); and by the National Cancer Institute of the US National Institutes of Health (CA83115). The sponsors had no role in the design and conduct of the study; in the collection, analysis, and interpretation of data; or in the preparation, review, or approval of the manuscript.
Conflicts of interest: None declared.