Melanoma In Situ Treated Successfully Using Imiquimod After Nonclearance with Surgery: Review of the Literature
Background The standard of care for melanoma in situ (MIS) is surgical removal by surgical excision with a 5‐mm margin or Mohs micrographic surgery, but as more and more MIS is diagnosed in the head and neck region, surgeries may not be an option for patients when the lesions are large or less well...
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| Veröffentlicht in: | Dermatologic surgery 2012-06, Vol.38 (6), p.937-946 |
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| creator | Ellis, Lixia Z. Cohen, Joel L. High, Whitney Stewart, Leslie |
| description | Background
The standard of care for melanoma in situ (MIS) is surgical removal by surgical excision with a 5‐mm margin or Mohs micrographic surgery, but as more and more MIS is diagnosed in the head and neck region, surgeries may not be an option for patients when the lesions are large or less well defined. In addition, when negative margins cannot be achieved without grossly disfiguring the patient or when patients have medical comorbidities that preclude a surgical option, other treatment modalities may be considered. Recently, topical treatment with an immunomodulator, imiquimod, has been proposed as an alternative treatment for MIS.
Objective
We report a case of MIS successfully treated with topical imiquimod cream. In addition, because there has not been any comprehensive review of the use of topical imiquimod on melanoma and MIS, we conducted an extensive literature search and reviewed the topic in detail.
Materials and Methods
Using the keywords “imiquimod,” “melanoma,” “melanoma‐in‐situ,” and “lentigo maligna,” we searched the literature using PubMed in an attempt to find all relevant articles on the use of imiquimod on MIS or melanoma.
Results
There were 46 reports involving 264 patients on the use of imiquimod on MIS or lentigo maligna. Twenty‐three reports were published on the use of imiquimod on metastatic melanoma involving 55 patients, and two articles were on melanoma, with two patients in total. In addition, there were two articles on the use of imiquimod on dysplastic or atypical nevi with a total of 13 subjects.
Conclusion
Imiquimod appears to be beneficial in the treatment of MIS and melanoma metastases when surgical options are not feasible. Imiquimod should not be used for removal of dysplastic or atypical nevi. The treatment regimens varied from study to study, and there are no randomized controlled trials in the literature. More studies are needed to develop a reliable and reproducible treatment regimen, to fully elucidate the role of imiquimod in the treatment of MIS and melanoma, and to determine the prognostic predictors for favorable responses to imiquimod. |
| doi_str_mv | 10.1111/j.1524-4725.2012.02362.x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1017982326</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1017982326</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3992-44a06384e69cf1c20b3a3d2b53a7844be16d3d024d8b0cf803f072f8f090b6da3</originalsourceid><addsrcrecordid>eNqNkE1v1DAQhi0EoqXwF5AvSFwS7HHiOEgcqvK10gIS2z1bjjNuvcpHayds99_jsEu54suM5Of1eB5CKGc5T-fdLuclFFlRQZkD45AzEBLyhyfk_PHiaepZJTNWcjgjL2LcsUTWgj0nZwBCqFKJczJ-w84MY2_oaqAbP830OqCZsKWb2VqM0c1dd6Db6Icbuur9_ez7saWXbsJAv4-D7dAEM1ikez_dplC4wXB4T3_iL497Ojo63SJd-4SbaQ74kjxzpov46lQvyPbzp-urr9n6x5fV1eU6s6KuISsKw6RQBcraOm6BNcKIFppSmEoVRYNctqJlULSqYdYpJhyrwCnHatbI1ogL8vb47l0Y72eMk-59tNilZXGco-aMV7UCATKh6ojaMMYY0Om74HsTDgnSi26904tVvVjVi279R7d-SNHXpylz02P7GPzrNwFvToCJ1nRuUeXjP05CKZmsEvfhyO19h4f__oD-uNkunfgNE76bXA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1017982326</pqid></control><display><type>article</type><title>Melanoma In Situ Treated Successfully Using Imiquimod After Nonclearance with Surgery: Review of the Literature</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><source>Journals@Ovid Complete</source><creator>Ellis, Lixia Z. ; Cohen, Joel L. ; High, Whitney ; Stewart, Leslie</creator><creatorcontrib>Ellis, Lixia Z. ; Cohen, Joel L. ; High, Whitney ; Stewart, Leslie</creatorcontrib><description>Background
The standard of care for melanoma in situ (MIS) is surgical removal by surgical excision with a 5‐mm margin or Mohs micrographic surgery, but as more and more MIS is diagnosed in the head and neck region, surgeries may not be an option for patients when the lesions are large or less well defined. In addition, when negative margins cannot be achieved without grossly disfiguring the patient or when patients have medical comorbidities that preclude a surgical option, other treatment modalities may be considered. Recently, topical treatment with an immunomodulator, imiquimod, has been proposed as an alternative treatment for MIS.
Objective
We report a case of MIS successfully treated with topical imiquimod cream. In addition, because there has not been any comprehensive review of the use of topical imiquimod on melanoma and MIS, we conducted an extensive literature search and reviewed the topic in detail.
Materials and Methods
Using the keywords “imiquimod,” “melanoma,” “melanoma‐in‐situ,” and “lentigo maligna,” we searched the literature using PubMed in an attempt to find all relevant articles on the use of imiquimod on MIS or melanoma.
Results
There were 46 reports involving 264 patients on the use of imiquimod on MIS or lentigo maligna. Twenty‐three reports were published on the use of imiquimod on metastatic melanoma involving 55 patients, and two articles were on melanoma, with two patients in total. In addition, there were two articles on the use of imiquimod on dysplastic or atypical nevi with a total of 13 subjects.
Conclusion
Imiquimod appears to be beneficial in the treatment of MIS and melanoma metastases when surgical options are not feasible. Imiquimod should not be used for removal of dysplastic or atypical nevi. The treatment regimens varied from study to study, and there are no randomized controlled trials in the literature. More studies are needed to develop a reliable and reproducible treatment regimen, to fully elucidate the role of imiquimod in the treatment of MIS and melanoma, and to determine the prognostic predictors for favorable responses to imiquimod.</description><identifier>ISSN: 1076-0512</identifier><identifier>EISSN: 1524-4725</identifier><identifier>DOI: 10.1111/j.1524-4725.2012.02362.x</identifier><identifier>PMID: 22338583</identifier><language>eng</language><publisher>Malden, MA: Wiley</publisher><subject>Administration, Topical ; Aged, 80 and over ; Aminoquinolines - administration & dosage ; Antibiotics. Antiinfectious agents. Antiparasitic agents ; Antineoplastic Agents - administration & dosage ; Antiviral agents ; Biological and medical sciences ; Biopsy ; Dermatology ; Facial Neoplasms - drug therapy ; Facial Neoplasms - pathology ; Facial Neoplasms - surgery ; Follow-Up Studies ; Humans ; Male ; Medical sciences ; Melanoma - drug therapy ; Melanoma - pathology ; Melanoma - surgery ; Mohs Surgery - methods ; Pharmacology. Drug treatments ; Skin Neoplasms - drug therapy ; Skin Neoplasms - pathology ; Skin Neoplasms - surgery ; Skin plastic surgery ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Tumors of the skin and soft tissue. Premalignant lesions</subject><ispartof>Dermatologic surgery, 2012-06, Vol.38 (6), p.937-946</ispartof><rights>2012 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3992-44a06384e69cf1c20b3a3d2b53a7844be16d3d024d8b0cf803f072f8f090b6da3</citedby><cites>FETCH-LOGICAL-c3992-44a06384e69cf1c20b3a3d2b53a7844be16d3d024d8b0cf803f072f8f090b6da3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1524-4725.2012.02362.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1524-4725.2012.02362.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26256067$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22338583$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ellis, Lixia Z.</creatorcontrib><creatorcontrib>Cohen, Joel L.</creatorcontrib><creatorcontrib>High, Whitney</creatorcontrib><creatorcontrib>Stewart, Leslie</creatorcontrib><title>Melanoma In Situ Treated Successfully Using Imiquimod After Nonclearance with Surgery: Review of the Literature</title><title>Dermatologic surgery</title><addtitle>Dermatol Surg</addtitle><description>Background
The standard of care for melanoma in situ (MIS) is surgical removal by surgical excision with a 5‐mm margin or Mohs micrographic surgery, but as more and more MIS is diagnosed in the head and neck region, surgeries may not be an option for patients when the lesions are large or less well defined. In addition, when negative margins cannot be achieved without grossly disfiguring the patient or when patients have medical comorbidities that preclude a surgical option, other treatment modalities may be considered. Recently, topical treatment with an immunomodulator, imiquimod, has been proposed as an alternative treatment for MIS.
Objective
We report a case of MIS successfully treated with topical imiquimod cream. In addition, because there has not been any comprehensive review of the use of topical imiquimod on melanoma and MIS, we conducted an extensive literature search and reviewed the topic in detail.
Materials and Methods
Using the keywords “imiquimod,” “melanoma,” “melanoma‐in‐situ,” and “lentigo maligna,” we searched the literature using PubMed in an attempt to find all relevant articles on the use of imiquimod on MIS or melanoma.
Results
There were 46 reports involving 264 patients on the use of imiquimod on MIS or lentigo maligna. Twenty‐three reports were published on the use of imiquimod on metastatic melanoma involving 55 patients, and two articles were on melanoma, with two patients in total. In addition, there were two articles on the use of imiquimod on dysplastic or atypical nevi with a total of 13 subjects.
Conclusion
Imiquimod appears to be beneficial in the treatment of MIS and melanoma metastases when surgical options are not feasible. Imiquimod should not be used for removal of dysplastic or atypical nevi. The treatment regimens varied from study to study, and there are no randomized controlled trials in the literature. More studies are needed to develop a reliable and reproducible treatment regimen, to fully elucidate the role of imiquimod in the treatment of MIS and melanoma, and to determine the prognostic predictors for favorable responses to imiquimod.</description><subject>Administration, Topical</subject><subject>Aged, 80 and over</subject><subject>Aminoquinolines - administration & dosage</subject><subject>Antibiotics. Antiinfectious agents. Antiparasitic agents</subject><subject>Antineoplastic Agents - administration & dosage</subject><subject>Antiviral agents</subject><subject>Biological and medical sciences</subject><subject>Biopsy</subject><subject>Dermatology</subject><subject>Facial Neoplasms - drug therapy</subject><subject>Facial Neoplasms - pathology</subject><subject>Facial Neoplasms - surgery</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Melanoma - drug therapy</subject><subject>Melanoma - pathology</subject><subject>Melanoma - surgery</subject><subject>Mohs Surgery - methods</subject><subject>Pharmacology. Drug treatments</subject><subject>Skin Neoplasms - drug therapy</subject><subject>Skin Neoplasms - pathology</subject><subject>Skin Neoplasms - surgery</subject><subject>Skin plastic surgery</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Tumors of the skin and soft tissue. Premalignant lesions</subject><issn>1076-0512</issn><issn>1524-4725</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkE1v1DAQhi0EoqXwF5AvSFwS7HHiOEgcqvK10gIS2z1bjjNuvcpHayds99_jsEu54suM5Of1eB5CKGc5T-fdLuclFFlRQZkD45AzEBLyhyfk_PHiaepZJTNWcjgjL2LcsUTWgj0nZwBCqFKJczJ-w84MY2_oaqAbP830OqCZsKWb2VqM0c1dd6Db6Icbuur9_ez7saWXbsJAv4-D7dAEM1ikez_dplC4wXB4T3_iL497Ojo63SJd-4SbaQ74kjxzpov46lQvyPbzp-urr9n6x5fV1eU6s6KuISsKw6RQBcraOm6BNcKIFppSmEoVRYNctqJlULSqYdYpJhyrwCnHatbI1ogL8vb47l0Y72eMk-59tNilZXGco-aMV7UCATKh6ojaMMYY0Om74HsTDgnSi26904tVvVjVi279R7d-SNHXpylz02P7GPzrNwFvToCJ1nRuUeXjP05CKZmsEvfhyO19h4f__oD-uNkunfgNE76bXA</recordid><startdate>201206</startdate><enddate>201206</enddate><creator>Ellis, Lixia Z.</creator><creator>Cohen, Joel L.</creator><creator>High, Whitney</creator><creator>Stewart, Leslie</creator><general>Wiley</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201206</creationdate><title>Melanoma In Situ Treated Successfully Using Imiquimod After Nonclearance with Surgery: Review of the Literature</title><author>Ellis, Lixia Z. ; Cohen, Joel L. ; High, Whitney ; Stewart, Leslie</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3992-44a06384e69cf1c20b3a3d2b53a7844be16d3d024d8b0cf803f072f8f090b6da3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Administration, Topical</topic><topic>Aged, 80 and over</topic><topic>Aminoquinolines - administration & dosage</topic><topic>Antibiotics. Antiinfectious agents. Antiparasitic agents</topic><topic>Antineoplastic Agents - administration & dosage</topic><topic>Antiviral agents</topic><topic>Biological and medical sciences</topic><topic>Biopsy</topic><topic>Dermatology</topic><topic>Facial Neoplasms - drug therapy</topic><topic>Facial Neoplasms - pathology</topic><topic>Facial Neoplasms - surgery</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Melanoma - drug therapy</topic><topic>Melanoma - pathology</topic><topic>Melanoma - surgery</topic><topic>Mohs Surgery - methods</topic><topic>Pharmacology. Drug treatments</topic><topic>Skin Neoplasms - drug therapy</topic><topic>Skin Neoplasms - pathology</topic><topic>Skin Neoplasms - surgery</topic><topic>Skin plastic surgery</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Tumors of the skin and soft tissue. Premalignant lesions</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ellis, Lixia Z.</creatorcontrib><creatorcontrib>Cohen, Joel L.</creatorcontrib><creatorcontrib>High, Whitney</creatorcontrib><creatorcontrib>Stewart, Leslie</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Dermatologic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ellis, Lixia Z.</au><au>Cohen, Joel L.</au><au>High, Whitney</au><au>Stewart, Leslie</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Melanoma In Situ Treated Successfully Using Imiquimod After Nonclearance with Surgery: Review of the Literature</atitle><jtitle>Dermatologic surgery</jtitle><addtitle>Dermatol Surg</addtitle><date>2012-06</date><risdate>2012</risdate><volume>38</volume><issue>6</issue><spage>937</spage><epage>946</epage><pages>937-946</pages><issn>1076-0512</issn><eissn>1524-4725</eissn><abstract>Background
The standard of care for melanoma in situ (MIS) is surgical removal by surgical excision with a 5‐mm margin or Mohs micrographic surgery, but as more and more MIS is diagnosed in the head and neck region, surgeries may not be an option for patients when the lesions are large or less well defined. In addition, when negative margins cannot be achieved without grossly disfiguring the patient or when patients have medical comorbidities that preclude a surgical option, other treatment modalities may be considered. Recently, topical treatment with an immunomodulator, imiquimod, has been proposed as an alternative treatment for MIS.
Objective
We report a case of MIS successfully treated with topical imiquimod cream. In addition, because there has not been any comprehensive review of the use of topical imiquimod on melanoma and MIS, we conducted an extensive literature search and reviewed the topic in detail.
Materials and Methods
Using the keywords “imiquimod,” “melanoma,” “melanoma‐in‐situ,” and “lentigo maligna,” we searched the literature using PubMed in an attempt to find all relevant articles on the use of imiquimod on MIS or melanoma.
Results
There were 46 reports involving 264 patients on the use of imiquimod on MIS or lentigo maligna. Twenty‐three reports were published on the use of imiquimod on metastatic melanoma involving 55 patients, and two articles were on melanoma, with two patients in total. In addition, there were two articles on the use of imiquimod on dysplastic or atypical nevi with a total of 13 subjects.
Conclusion
Imiquimod appears to be beneficial in the treatment of MIS and melanoma metastases when surgical options are not feasible. Imiquimod should not be used for removal of dysplastic or atypical nevi. The treatment regimens varied from study to study, and there are no randomized controlled trials in the literature. More studies are needed to develop a reliable and reproducible treatment regimen, to fully elucidate the role of imiquimod in the treatment of MIS and melanoma, and to determine the prognostic predictors for favorable responses to imiquimod.</abstract><cop>Malden, MA</cop><pub>Wiley</pub><pmid>22338583</pmid><doi>10.1111/j.1524-4725.2012.02362.x</doi><tpages>10</tpages></addata></record> |
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| ispartof | Dermatologic surgery, 2012-06, Vol.38 (6), p.937-946 |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; Journals@Ovid Complete |
| subjects | Administration, Topical Aged, 80 and over Aminoquinolines - administration & dosage Antibiotics. Antiinfectious agents. Antiparasitic agents Antineoplastic Agents - administration & dosage Antiviral agents Biological and medical sciences Biopsy Dermatology Facial Neoplasms - drug therapy Facial Neoplasms - pathology Facial Neoplasms - surgery Follow-Up Studies Humans Male Medical sciences Melanoma - drug therapy Melanoma - pathology Melanoma - surgery Mohs Surgery - methods Pharmacology. Drug treatments Skin Neoplasms - drug therapy Skin Neoplasms - pathology Skin Neoplasms - surgery Skin plastic surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Tumors of the skin and soft tissue. Premalignant lesions |
| title | Melanoma In Situ Treated Successfully Using Imiquimod After Nonclearance with Surgery: Review of the Literature |
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