BACKGROUND The first choice of treatment for lentigo maligna (LM) is excision. Initial studies of treatment with imiquimod 5% cream have shown promising results with excellent cosmetic outcome, but... Show moreBACKGROUND The first choice of treatment for lentigo maligna (LM) is excision. Initial studies of treatment with imiquimod 5% cream have shown promising results with excellent cosmetic outcome, but the follow-up duration in these studies was short. OBJECTIVES To evaluate the results of treatment of patients with LM with imiquimod in routine clinical practice with long-term follow-up. METHODS We prospectively followed 10 patients with LM who were treated with imiquimod 5% cream between 2004 and 2007 with a median follow-up of 31 months (range 11-56 months). Histological clearance was assessed in all patients using post-treatment biopsies. RESULTS Complete clinical clearance was achieved in nine of 10 patients after treatment with imiquimod. During follow-up, three clinical and histological recurrences were observed at 9, 10, and 27 months after treatment cessation. In a fourth patient, histological recurrence without clinical signs was demonstrated 17 months after treatment. Five of 10 patients are in sustained clinical remission. CONCLUSIONS Imiquimod appears to be an effective treatment for a subset of patients with LM. We recommend long-term follow-up and taking multiple post-treatment biopsies, even in the absence of a clinical recurrence. This case series emphasizes the need for finding an optimal treatment regimen. Show less
