Images in Clinical Medicine

Lentigo Maligna

Bernard Noel, M.D., and Nathalie Kunzle, M.D.

N Engl J Med 2005; 353:2176November 17, 2005

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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.

Bernard Noel, M.D.
Nathalie Kunzle, M.D.
Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland

Citing Articles (5)

Citing Articles

1. 1

   Kristen L. Toren, Eric C. Parlette. (2010) Managing Melanoma In Situ. Seminars in Cutaneous Medicine and Surgery 29:4, 258-263
   CrossRef

2. 2

   Corinne Erickson, Stanley J. Miller. (2010) Treatment options in melanoma in situ: topical and radiation therapy, excision and Mohs surgery. International Journal of Dermatology 49:5, 482-491
   CrossRef

3. 3

   MAGDALENA DE TROYA-MARTÍN, MARTA FRIEYRO-ELICEGUI, RAFAEL FÚNEZ LIÉBANA, MIGUEL AGUILAR BERNIER, N. INES FERNÁNDEZ-CANEDO, NURIA BLÁZQUEZ SÁNCHEZ. (2008) Lentigo Maligna Managed with Topical Imiquimod and Dermoscopy: Report of Two Cases. Dermatologic Surgery 34:11, 1561-1566
   CrossRef

4. 4

   S.F. Rajpar, J.R. Marsden. (2006) Imiquimod in the treatment of lentigo maligna. British Journal of Dermatology 155:4, 653-656
   CrossRef

5. 5

   (2006) Lentigo Maligna and Radiotherapy. New England Journal of Medicine 354:12, 1322-1322
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