Imiquimod 5% cream as primary or adjuvant therapy for melanoma in situ, lentigo maligna type
Imiquimod 5% cream as primary or adjuvant therapy for melanoma in situ, lentigo maligna type
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DOI：
10.1016/j.jaad.2015.02.008
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发表时间：
2015-06-01
影响因子：
13.8
通讯作者：
Egbert, Barbara M.
中科院分区：
文献类型：
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作者：
Swetter, Susan M.;Chen, Frank W.;Egbert, Barbara M.
背景：恶性雀斑样痣 (LM) 的手术切除因老年个体日晒损伤皮肤中的不连续、亚临床扩展和光化性黑素细胞增生而变得复杂。目的：我们试图确定咪喹莫特作为 LM 主要或辅助治疗的长期有效性。方法：回顾性识别 2003 年 1 月 1 日至 2013 年 12 月 31 日期间患有 LM、早期/进展中的 LM 和 LM 黑色素瘤，在诊断性活检后使用局部咪喹莫特乳膏进行主要治疗，或在窄缘手术切除或完全临床但未组织学切除 LM 后进行辅助治疗。随访截至 2014 年 12 月 31 日。结果：总共 61 名患者中发现 63 例，平均 (SD) 年龄 71.1 (12.4) 岁；对 58 例进行了局部复发分析。 63 例中有 22 例（34.9%）使用咪喹莫特作为主要治疗，63 例中有 41 例（65.1%）使用咪喹莫特作为辅助治疗，平均持续时间为 11.7（范围 2-60）周。 50 例 (86.2%) 在平均 (SD) 随访 42.1 (27.4) 个月时表现出临床清除率：在 39.7 (23.9) 个月和 43.1 (28.9) 个月时分别有 72.7% 的初级治疗和 94.4% 的辅助治疗。 局限性： 回顾性队列研究和缺乏标准化的咪喹莫特应用是局限性的。 结论： 咪喹莫特乳膏似乎是以下患者的可行选择：对不适合手术的老年患者进行 LM 的主要或辅助治疗。
Background: Surgical resection of lentigo maligna (LM) is complicated by noncontiguous, subclinical extension and actinic melanocytic hyperplasia in sun-damaged skin of older individuals.Objective: We sought to determine the long-term effectiveness of imiquimod as primary or adjuvant therapy for LM.Methods: Patients were retrospectively identified from January 1, 2003, to December 31, 2013, with LM, early/evolving LM, and LM melanoma who had used topical imiquimod 5% cream for either primary therapy after diagnostic biopsy, or adjuvant therapy after narrow-margin surgical resection or complete clinical but not histologic resection of LM. Follow-up occurred through December 31, 2014.Results: In all, 63 cases were identified in 61 patients, mean (SD) age 71.1 (12.4) years; 58 were analyzed for local recurrence. Imiquimod was used as primary therapy in 22 of 63 (34.9%) and adjuvant therapy in 41 of 63 (65.1%) for mean duration of 11.7 (range 2-60) weeks. Fifty cases (86.2%) demonstrated clinical clearance at mean (SD) follow-up of 42.1 (27.4) months: 72.7% primary and 94.4% adjuvant at 39.7 (23.9) and 43.1 (28.9) months, respectively.Limitations: Retrospective cohort study and lack of standardized imiquimod application are limitations.Conclusion: Imiquimod cream appears to be a viable option for primary or adjuvant treatment of LM in older patients who are poor surgical candidates.