Rate of Recurrence of Lentigo Maligna Treated With Topical Imiquimod 5% Cream Prior to Conservatively Staged Excision

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In this retrospective analysis, the authors evaluated 334 patients with 345 biopsy-confirmed lentigo maligna (LM) tumors who were treated with topical imiquimod 5% cream prior to staged tumor excision. Patients were treated 5 nights weekly for 2 to 3 months prior to surgery and were followed monthly to assess inflammatory response to imiquimod. Those deemed to have an inadequate response were also treated with tazarotene 0.1% gel twice weekly. Staged excision began with a conservative 2.0-mm margin, and 81% of patients had clear margins after the first stage. The mean surgical margin requirement was 3.5 mm. Prior studies have reported surgical margin requirements for LM as high 7 to 15 mm when treating with staged excision alone. The recurrence rate was 3.9% at 5.5 years, which is similar to the previously reported recurrence rate for LM of 4% at 5 years.
Neoadjuvant treatment of LM with topical imiquimod 5% cream resulted in a lower mean surgical margin requirement and recurrence rate similar to that reported with excision alone. Cosmetic defects were smaller, an important consideration in treating tumors that typically occur in cosmetically sensitive areas such as the head and neck.
– Caitlyn T. Reed, MD