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An 81-year-old woman was referred for treatment of two asymmetric, poorly circumscribed pigmented macules on the left cheek. The pigmentation was variegated, ranging from light brown to retiform areas of black (Panel A). The histopathological diagnosis was lentigo maligna, a form of melanoma in situ. Instead of treatment with a large excision, imiquimod cream (5 percent concentration) was applied for eight hours twice weekly for 12 weeks. During the treatment, the patient reported only minor localized skin irritation. After three months of treatment, the macules completely disappeared, as confirmed by two skin biopsies. One year later, the skin was without evidence of recurrence and showed only mild erythema (Panel B).
Imiquimod is a member of a new class of drugs that stimulate the immune system. It is approved for the treatment of anogenital warts, actinic keratoses, and superficial basal-cell carcinomas. Recently, several reports have demonstrated that imiquimod cream may also be effective for the treatment of lentigo maligna, raising the possibility of nonsurgical management of this type of melanoma, which is usually located on the face. Careful follow-up is indicated.
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