Clearance of Invasive Melanoma With Topical Imiquimod

January 2013 | Volume 12 | Issue 1 | Case Report | 107 | Copyright © 2013

Summer D. Moon BS a and James M. Spencer MD MS b

aLake Erie College of Osteopathic Medicine, Bradenton, FL bMount Sinai School of Medicine, New York, NY

Abstract

A 93-year-old woman presented with biopsy-proven invasive melanoma of 2.75 mm depth, arising from a melanoma in situ. Standard treatment of this depth would be an extensive and mutilating excision, which presented a therapeutic dilemma. Imiquimod has the ability to clear melanoma in situ, but its effect on invasive melanoma is unknown. After a thorough discussion with the patient, we decided to attempt to treat the melanoma in situ with topical imiquimod and then excise the smaller invasive component. Following 5 weeks of topical imiquimod therapy, the area where the nodular melanoma had previously been was excised. Histological examination of the excisional specimen revealed no residual melanoma detected. In this case, it appears that 5 weeks of topical imiquimod therapy completely cleared an invasive melanoma of 2.75 mm depth, as well as clearing the component of melanoma in situ. The patient was followed for 14 months with no evidence of recurrence.

J Drugs Dermatol. 2013;12(1):107-108.

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INTRODUCTION

A frail 93-year-old woman with multiple medical problems presented with a biopsy-proven melanoma in situ involving the entire left lower eyelid, involving the conjunctiva and extending several centimeters into the cheek and lateral canthus. In the middle, there was a nodule, which was a biopsy-proven invasive melanoma of 2.75 mm depth (Figure 1). Computed tomography of the head and neck revealed no lymphatic spread. Standard treatment of this depth would involve 2.00 cm margins in all directions, as well as a sentinel lymph node biopsy, which would probably involve the parotid and neck lymph nodes. In this case, that would be an extensive and mutilating excision, which presented a therapeutic dilemma.

It has been reported in the literature that topical imiquimod has the ability to clear melanoma in situ and lentigo maligna.1,2 Its effect on invasive melanoma is unknown, although Spieth and colleagues reported on a patient with recurrent oral mucosal melanoma that responded to imiquimod with clinical and histological clearance.3

After extensive discussion with the patient, we decided to forgo sentinel lymph node biopsy, and instead, to attempt to treat the melanoma in situ with topical imiquimod and then excise the smaller invasive component. The patient completed 5 weeks of topical imiquimod therapy and returned to the office with profound inflammation (Figure 2). The inflammation was allowed to resolve for 10 days (Figure 3), after which the area where the nodular melanoma had previously been was excised with a 1.00 cm margin (Figure 4). This was immediately repaired with an advancement flap (Figure 5). Histological examination of the excisional specimen revealed no residual melanoma detected. The block of tissue was extensively examined, and again, absolutely no residual melanoma was detected.

In this case, it appears that 5 weeks of topical imiquimod therapy completely cleared an invasive melanoma of 2.75 mm depth, as well as clearing the component of melanoma in situ. Clearance of invasive melanoma of this magnitude by topical imiquimod has not been previously reported. The patient was followed for 14 months with no evidence of recurrence (Figure 6). Further study is required, but topical imiquimod may represent a new topical modality for invasive melanoma.

"In this case, it appears that 5 weeks of topical imiquimod therapy completely cleared an invasive melanoma of 2.75 mm depth, as well as clearing the component of melanoma in situ."


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