Abstract
The treatment of melanoma in situ (MIS) is controversial with current standard of care being surgical excision with clear margins. Alternative topical therapy with imiquimod has been proposed in recent studies as a possible treatment for MIS. This study aimed to evaluate the use of topical 5% imiquimod as an alternative approach for the treatment of residual melanoma in situ after surgical resection of the primary lesion. A retrospective chart review of all patients treated with topical 5% imiquimod for residual MIS following standard resection with 5–10 mm margins at Yale-New Haven Hospital from 2008 through 2013 was performed. The pre- and posttreatment results were confirmed by diagnostic tissue biopsy. Twenty-two patients were included in the study. One of these 22 patients was lost to follow up. Twenty patients (95%) had complete resolution of their residual MIS and 1 patient did not respond to imiquimod (5%). No reports of recurrences were noted at the treatment sites. For patients with residual melanoma in situ after the initial excision, topical 5% imiquimod appears to be a reasonable alternative treatment with good clinical and histopathologic success rates.
Highlights
Melanoma in situ (MIS) refers to early noninvasive melanoma confined to the epidermis and accounts for ~27% of all melanomas [1]
We performed a retrospective chart review of patients treated with topical 5% imiquimod cream for MIS that had persisted after initial surgical excision of melanoma or melanoma in situ
Twenty patients (95%) had an excellent response with complete resolution of their residual MIS at a mean follow-up period of 24 months. This was confirmed by a minimum of two 4-mm punch biopsies of the affected margins following the treatment
Summary
Melanoma in situ (MIS) refers to early noninvasive melanoma confined to the epidermis and accounts for ~27% of all melanomas [1]. The nonsurgical options for treatment of MIS include radiotherapy, cryotherapy, laser, and electrodessication and curettage These nonsurgical options are generally reserved for elderly patients who are unsuitable for surgery, for patients with extensive involvement of the skin that is not amenable to surgical intervention given the likelihood of a poor cosmetic outcome, or when unresectable areas of the face are involved. Multiple pharmacological agents such as 5-fluorouracil, azelaic acid, retinoic acid derivatives, and interferon (IFN)-a have been used for the treatment of MIS with success rates varying between 30% and 92% [6].
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