Ivette Alarcon1, Cristina Carrera2, Llucia Alos3, Josep Palou4, Josep Malvehy2, Susana Puig5. 1. Dermatology Department, Melanoma Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Institut de Recerca Biomédica August Pi i Sunyer (IDIBAPS), Barcelona, Spain. 2. Dermatology Department, Melanoma Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Institut de Recerca Biomédica August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain. 3. Pathology Department, Melanoma Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain. 4. Pathology Department, Melanoma Unit, Hospital Clinic of Barcelona, Barcelona, Spain. 5. Dermatology Department, Melanoma Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Institut de Recerca Biomédica August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain. Electronic address: susipuig@gmail.com.
Abstract
BACKGROUND: Imiquimod has been used for treating lentigo maligna (LM) in selected cases when surgery is not an appropriate option because of functional or aesthetic impairment. Reflectance confocal microscopy (RCM) is a noninvasive method that has not been validated for monitoring the treatment of LM with imiquimod. OBJECTIVE: We sought to evaluate the use of in vivo RCM to accurately monitor the response of LM to nonsurgical treatment with topical imiquimod. METHODS: Twenty patients with confirmed facial LM, not amenable to surgical treatment or radiation therapy, were included prospectively. Clinical evaluation was performed by dermoscopy, RCM, and histopathology. Patients applied imiquimod 5% for 8 weeks. The affected area was assessed using the previously described LM score on RCM, and target sample biopsies were performed to confirm or discard RCM findings. RESULTS: Fifteen of the 20 patients (75%) presented histologic tumor clearance. Confocal microscopy identified 70% of these responders with no false-negative results, and when compared with histopathology, there was no significant difference in evaluating the response to imiquimod. LIMITATIONS: The impossibility of examining the entire lesion by means of histopathology is a limitation. CONCLUSION: In vivo RCM evaluation was useful in accurately monitoring the response of LM to nonsurgical treatment with topical imiquimod in patients when surgery is contraindicated.
BACKGROUND: Imiquimod has been used for treating lentigo maligna (LM) in selected cases when surgery is not an appropriate option because of functional or aesthetic impairment. Reflectance confocal microscopy (RCM) is a noninvasive method that has not been validated for monitoring the treatment of LM with imiquimod. OBJECTIVE: We sought to evaluate the use of in vivo RCM to accurately monitor the response of LM to nonsurgical treatment with topical imiquimod. METHODS: Twenty patients with confirmed facial LM, not amenable to surgical treatment or radiation therapy, were included prospectively. Clinical evaluation was performed by dermoscopy, RCM, and histopathology. Patients applied imiquimod 5% for 8 weeks. The affected area was assessed using the previously described LM score on RCM, and target sample biopsies were performed to confirm or discard RCM findings. RESULTS: Fifteen of the 20 patients (75%) presented histologic tumor clearance. Confocal microscopy identified 70% of these responders with no false-negative results, and when compared with histopathology, there was no significant difference in evaluating the response to imiquimod. LIMITATIONS: The impossibility of examining the entire lesion by means of histopathology is a limitation. CONCLUSION: In vivo RCM evaluation was useful in accurately monitoring the response of LM to nonsurgical treatment with topical imiquimod in patients when surgery is contraindicated.
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