Treatment of melanoma in-transit metastases with combination intralesional interleukin-2, topical imiquimod, and tretinoin 0.1% cream

Abstract

The treatment of in-transit and satellite melanoma metastases is challenging. Treatment options for these cutaneous and subcutaneous lesions include surgical excision, radiotherapy, isolated limb infusion/perfusion, electrochemotherapy, cryotherapy, laser therapy (pulsed dye or carbon dioxide), systemic treatment with interferon-α or interleukin-2 (IL-2), topical imiquimod, dinitrochlorobenzene, and intralesional immunotherapy with bacillus Calmette-Guerin vaccine, granulocyte macrophage colony-stimulating factor, IL-2, or talimogene laherparepvec.1 Response rates for these therapies are often suboptimal. Topical imiquimod has been used for the treatment of both melanoma in situ (in patients who are either poor surgical candidates or have positive margins after excision) and in-transit metastases.1, 2 There are reports of regression of locoregional melanoma metastases after topical imiquimod to cutaneous lesions.1, 2 Combination therapy using intralesional IL-2 together with topical imiquimod and tretinoin may increase the efficacy of IL-2.3 Here we report the case of a patient with in-transit metastatic melanoma treated with intratumoral IL-2 together with topical imiquimod and tretinoin cream.