Powell A M, Russell-Jones R, Barlow R J
The Skin Tumour Unit, St John's Institute of Dermatology, St Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, UK.
Clin Exp Dermatol. 2004 Jan;29(1):15-21. doi: 10.1111/j.1365-2230.2004.01452.x.
Melanoma in situ of the lentigo maligna (LM) type is a precursor lesion of LM melanoma. It most commonly occurs in elderly individuals, on the head and neck. Although surgical excision is recommended, this may not be practical for large lesions at cosmetically sensitive sites. In addition, histological changes commonly extend beyond the clinical margins of the lesion. This study describes the use of imiquimod 5% cream as topical immunotherapy in the management of lentigo maligna. Twelve patients (average age 63 years, 10 female), of biopsy-proven facial LM were treated with topical imiquimod, three times a week for 6 weeks. In the absence of an inflammatory response, patients were asked to apply the treatment daily. Seven showed clearance of the LM clinically and histologically. A further three patients showed clearance histologically with persisting pigmentation due to dermal melanin and melanophages. Thus, 10 of 12 patients cleared with no relapse after a median follow-up of 6 months. Two patients failed to respond to imiquimod and their lesions were treated with surgical excision. Imiquimod was well tolerated, except in three patients who experienced an intense inflammatory response. Two of these also developed secondary infection. Imiquimod 5% cream appears to offer a potential noninvasive method for the treatment of lentigo maligna.
恶性雀斑样痣原位黑色素瘤（LM）是LM黑色素瘤的前驱病变。它最常见于老年人的头颈部。虽然推荐手术切除，但对于美容敏感部位的大病变，这可能不实用。此外，组织学变化通常超出病变的临床边界。本研究描述了5%咪喹莫特乳膏作为局部免疫疗法在恶性雀斑样痣治疗中的应用。12例经活检证实为面部LM的患者（平均年龄63岁，10例女性）接受局部咪喹莫特治疗，每周3次，共6周。若没有炎症反应，要求患者每日进行治疗。7例患者的LM在临床和组织学上均清除。另外3例患者组织学上清除，但由于真皮内黑色素和噬黑素细胞导致色素沉着持续存在。因此，12例患者中有10例在中位随访6个月后清除且无复发。2例患者对咪喹莫特无反应，其病变接受了手术切除。咪喹莫特耐受性良好，除了3例出现强烈炎症反应的患者。其中2例还发生了继发感染。5%咪喹莫特乳膏似乎为恶性雀斑样痣的治疗提供了一种潜在的非侵入性方法。
