TY - JOUR
T1 - Efficacy of imiquimod cream, 5%, for lentigo maligna after complete excision: A study of 43 patients
AU - Ly, Lena
AU - Kelly, John W
AU - O'Keefe, Rodney
AU - Sutton, Tina
AU - Dowling, John
AU - Swain, Sarah
AU - Byrne, Marguerite
AU - Curr, Nathan
AU - Wolfe, Rory
AU - Chamberlain, Alexander
AU - Haskett, Martin
PY - 2011
Y1 - 2011
N2 - To determine the efficacy of imiquimod
cream, 5 , in the treatment of lentigo maligna (LM).
Design: Open-label before-and-after interventional study.
Setting: A multidisciplinary melanoma clinic at a major
tertiary hospital.
Patients: Forty-three patients with biopsy-proven LM
of greater than 5 mm in diameter completed this study.
Interventions: Imiquimod cream, 5 , was applied to
the lesion 5 days a week for 12 weeks. The original lesion
was excised with a 5-mm margin.
Main Outcome Measures: The primary outcome was
histopathologic evidence of LM in the excision specimen
assessed independently by 2 of 3 dermatopathologists.
Visible inflammation during treatment and macroscopic
clearance were recorded.
Results: When 5 of the 43 patients with discordant histopathologic
assessment of the excision specimen were
excluded, 20 of 38 patients (53 [95 confidence
interval, 36 -69 ) demonstrated histopathologic clearance
of LM after imiquimod treatment. Visible inflammation
was significantly associated with histopathologic
clearance (P=.04), but the positive predictive value was
low (62 ). Macroscopic clearance showed some association
with histopathologic clearance (P=.11). Dermatopathologist
concordance for all 43 specimens was substantial
( =0.77; 95 confidence interval, 0.57-0.96).
Conclusions: Imiquimod cream, 5 , has limited efficacy
in the treatment ofLMwhendeterminedbyhistopathologic
assessment of the entire treated area. The clinical signs of
visible inflammation during treatment and apparent lesion
clearance cannot be relied on to assess efficacy.
AB - To determine the efficacy of imiquimod
cream, 5 , in the treatment of lentigo maligna (LM).
Design: Open-label before-and-after interventional study.
Setting: A multidisciplinary melanoma clinic at a major
tertiary hospital.
Patients: Forty-three patients with biopsy-proven LM
of greater than 5 mm in diameter completed this study.
Interventions: Imiquimod cream, 5 , was applied to
the lesion 5 days a week for 12 weeks. The original lesion
was excised with a 5-mm margin.
Main Outcome Measures: The primary outcome was
histopathologic evidence of LM in the excision specimen
assessed independently by 2 of 3 dermatopathologists.
Visible inflammation during treatment and macroscopic
clearance were recorded.
Results: When 5 of the 43 patients with discordant histopathologic
assessment of the excision specimen were
excluded, 20 of 38 patients (53 [95 confidence
interval, 36 -69 ) demonstrated histopathologic clearance
of LM after imiquimod treatment. Visible inflammation
was significantly associated with histopathologic
clearance (P=.04), but the positive predictive value was
low (62 ). Macroscopic clearance showed some association
with histopathologic clearance (P=.11). Dermatopathologist
concordance for all 43 specimens was substantial
( =0.77; 95 confidence interval, 0.57-0.96).
Conclusions: Imiquimod cream, 5 , has limited efficacy
in the treatment ofLMwhendeterminedbyhistopathologic
assessment of the entire treated area. The clinical signs of
visible inflammation during treatment and apparent lesion
clearance cannot be relied on to assess efficacy.
UR - http://archderm.ama-assn.org/cgi/reprint/147/10/1191
U2 - 10.1001/archdermatol.2011.260
DO - 10.1001/archdermatol.2011.260
M3 - Article
VL - 147
SP - 1191
EP - 1195
JO - Archives of Dermatology
JF - Archives of Dermatology
SN - 0003-987X
IS - 10
ER -