{"id":333615,"date":"2020-08-12T02:00:00","date_gmt":"2020-08-12T00:00:00","guid":{"rendered":"https:\/\/medizinonline.com\/immunomodulator-as-a-treatment-option-for-lentigo-maligna\/"},"modified":"2020-08-12T02:00:00","modified_gmt":"2020-08-12T00:00:00","slug":"immunomodulator-as-a-treatment-option-for-lentigo-maligna","status":"publish","type":"post","link":"https:\/\/medizinonline.com\/en\/immunomodulator-as-a-treatment-option-for-lentigo-maligna\/","title":{"rendered":"Immunomodulator as a treatment option for lentigo maligna"},"content":{"rendered":"

Surgical excision is still considered the first choice, but recent findings also attest to an important role for imiquimod in the treatment of this dangerous carcinogenic skin lesion.<\/strong><\/p>\n

<\/p>\n

Lentigo maligna (LM) is present in 79-83% of all melanoma in situ tumors [1]. In recent years, the number of new cases of this subtype of preinvasive melanoma has increased markedly. The age-standardized incidence rate of melanocytic tumors in general has increased more than fivefold in Central Europe over the last fifty years [1\u20133].<\/p>\n

Alternative or complementary to excision<\/h2>\n

The likelihood of lentigo maligna (LM) developing into lentigo maligna melanoma (LMM) if left untreated is relatively high. A study published in 2019 examined lesions from 682 patients and found that the estimated risk of progression from LM to LMM was 3.5% per year [4]. Surgical removal remains the first choice of treatment, but alternative treatment options are now available. According to NCCN guidelines, these include radiotherapy or topical therapy with imiquimod [5]. Recent long-term data on off-label use of imiquimod in LM attest to a clearance of 72% for the follow-up period of 4.1 years (n=33) [6]. The treatment duration was 6 weeks, and the therapy frequency was 5 days per week. <\/p>\n

This replicated the results of a study published in 2015, in which a clearance rate of 86.2% was achieved [7]. Also as a neoadjuvant prior to surgical excision, the therapeutic outcome of imiquimod is positive: In a large study including 345 excised biopsies, the recurrence rate was 3.9% within a follow-up period of 5.5 years, and the median time to recurrence was 4.3 years [8]. Treatment with Imiquimod 5% cream was given for a period of 2-3 months on 5 days per week. In combination with tazarotene, there was no recurrence after a follow-up period of 3.5 years [8].<\/p>\n

Diagnostically a “Challenge<\/h2>\n

Lentigo maligna is predominantly found on actinically damaged skin on light-exposed areas such as the face, neck, forearms, hands and lower legs. As a sun-exposed part of the body, the face is a common site of localization, with about half of LMs located in the torso area, according to a study published in 2018 [1,2,9]. The ABCDE rule of dermoscopy should not be used on the face [1,2]. How does the skin change manifest itself clinically? Characteristic are inhomogeneous, brown to black, blurred plane foci of varying size. If at least one of the following features of non-melanocytic lesions is not met, a biopsy should be performed [10]: 1) scales, 2) white follicles, 3) erythema, 4) reticular or curved lines, 5) structureless brown color, 6) sharp demarcation, 7) milia-like cysts.<\/p>\n

Incisional biopsy should be performed at the clinically thickest site [1]. Approximately 9% of LM detected by biopsy are reclassified as LMM or melanoma after complete excision [11]. Reflectance confocal microscopy (RCM) is particularly useful for delineating the lateral margins of LM, as well as for monitoring non-surgically treated lesions and avoiding unnecessary excision of benign tumors [1]. RCM and histopathology lead to the identical result in 88% of cases [1]. Also helpful is RCM if it is the rare subtype of non-melanocytic lentigo maligna, as it reveals the dendritic pagetoid cells characteristic of this rare subtype [1]. Histopathologically, LM are characterized by atypical melanocytes in the stratum basale on a background of solar elastosis. The solitary and nested atypical melanocytes proliferate along the dermo-epidermal junctional zone. Follicular involvement is a histopathologic feature present in 95.8% of LM, according to a 2019 study published in JAAD [12].<\/p>\n

 <\/p>\n\n\n\n
Summary<\/strong><\/p>\n
    \n
  • Incidence rates of lentigo maligna (LM) and melanocytic tumors in general have increased sharply in recent years.<\/li>\n
  • Surgical excision is still considered the first choice. As a topical off-label treatment option, the immunomodulator imiquimod also has a good track record with high clearance rates [1,5].<\/li>\n
  • In a long-term study by Papanikolaou et al. In 2019, imiquimod achieved 72% clearance for the follow-up period of 4.1 years (n=33) [6].<\/li>\n
  • The conclusion on imiquimod as a neoadjuvant prior to surgical excision is also positive: Donigan et al. 2018 report a recurrence rate of 3.9% within a follow-up period of 5.5 years [8].<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

     <\/p>\n

    Literature:<\/p>\n

      \n
    1. Cosgarea R: Lentigo maligna. Prof. Dr. Rodica Cosgarea, EADV Congress, Madrid, 11.10.2019.<\/li>\n
    2. DeWane ME : JAAD 2019; 81 (3): 823-833.<\/li>\n
    3. Guitera P, et al: Australas J Dermatol 2019; 60(2): 118-125.<\/li>\n
    4. Menzies SW, et al: Melanoma Res 2020; 30(2): 193-197.<\/li>\n
    5. National Comprehensive Cancer Network (NCCN), Guidelines 2. 2018, www.nccn.org<\/li>\n
    6. Papanikolaou M, Lawrence CM: Clin Exp Dermatol 2019; 44(6): 631-636.<\/li>\n
    7. Swetter SM, et al: J Am Dermatol 2015; 72(6): 1047-1053.<\/li>\n
    8. Donigan JM, et al: JAMA Dermatol 2018; 154(8): 885-889.<\/li>\n
    9. Duarte AF et al: Dermatology 2018; 234: 37-42.<\/li>\n
    10. Tschandl P, et al: Acta Derm Venereol 2017 15;97(10):1219-1224.<\/li>\n
    11. Zoutendijk J, et al: Br J Dermatol 2019; 181(2): 383-384.<\/li>\n
    12. Connolly KL, et al: J Am Acad Dermatol 2019 ; 80(2): 532-537.<\/li>\n
    13. Y\u00e9lamos O, et al: JAMA Dermatol 2017; 153(12): 1278-1284.<\/li>\n<\/ol>\n

       <\/p>\n

      DERMATOLOGY PRACTICE 2020; 30(3): 32<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

      Surgical excision is still considered the first choice, but recent findings also attest to an important role for imiquimod in the treatment of this dangerous carcinogenic skin lesion.<\/p>\n","protected":false},"author":7,"featured_media":97331,"comment_status":"closed","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"pmpro_default_level":"","cat_1_feature_home_top":false,"cat_2_editor_pick":false,"csco_eyebrow_text":"Skin cancer ","footnotes":""},"category":[11340,11508,11370,11548],"tags":[24315,24326,24331,24322,24314,24317,12340,24319,11795,24329],"powerkit_post_featured":[],"class_list":["post-333615","post","type-post","status-publish","format-standard","has-post-thumbnail","category-dermatology-and-venereology","category-education","category-oncology","category-rx-en","tag-neoadjuvant-therapy","tag-carcinogenic-skin-lesion","tag-clearance-rates","tag-imiquimod-en","tag-immunomodulator","tag-lentigo-maligna-en","tag-skin-cancer","tag-surgical-excision","tag-therapy-en","tag-topical-treatment-alternative","pmpro-has-access"],"acf":[],"publishpress_future_action":{"enabled":false,"date":"2026-04-24 12:48:11","action":"change-status","newStatus":"draft","terms":[],"taxonomy":"category","extraData":[]},"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"wpml_current_locale":"en_US","wpml_translations":{"fr_FR":{"locale":"fr_FR","id":333640,"slug":"un-immunomodulateur-comme-option-de-traitement-du-lentigo-malin","post_title":"Un immunomodulateur comme option de traitement du lentigo malin","href":"https:\/\/medizinonline.com\/fr\/un-immunomodulateur-comme-option-de-traitement-du-lentigo-malin\/"},"it_IT":{"locale":"it_IT","id":333646,"slug":"immunomodulatore-come-opzione-di-trattamento-per-la-lentigo-maligna","post_title":"Immunomodulatore come opzione di trattamento per la lentigo maligna","href":"https:\/\/medizinonline.com\/it\/immunomodulatore-come-opzione-di-trattamento-per-la-lentigo-maligna\/"},"pt_PT":{"locale":"pt_PT","id":333647,"slug":"imunomodulador-como-opcao-de-tratamento-para-lentigo-maligno","post_title":"Imunomodulador como op\u00e7\u00e3o de tratamento para lentigo maligno","href":"https:\/\/medizinonline.com\/pt-pt\/imunomodulador-como-opcao-de-tratamento-para-lentigo-maligno\/"},"es_ES":{"locale":"es_ES","id":333605,"slug":"inmunomodulador-como-opcion-de-tratamiento-para-el-lentigo-maligno","post_title":"Inmunomodulador como opci\u00f3n de tratamiento para el lentigo maligno","href":"https:\/\/medizinonline.com\/es\/inmunomodulador-como-opcion-de-tratamiento-para-el-lentigo-maligno\/"}},"_links":{"self":[{"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/posts\/333615","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/comments?post=333615"}],"version-history":[{"count":0,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/posts\/333615\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/media\/97331"}],"wp:attachment":[{"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/media?parent=333615"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/category?post=333615"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/tags?post=333615"},{"taxonomy":"powerkit_post_featured","embeddable":true,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/powerkit_post_featured?post=333615"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}