Department of Environmental Dermatology and Venereology, Medical University of Graz, Austria.
Acta Derm Venereol. 2011 Jun;91(4):432-5. doi: 10.2340/00015555-1099.
Basal cell carcinoma and actinic keratosis are frequent neoplasms. Topical treatments include the recently approved imiquimod cream. We describe here the case of a 68-year-old man with multiple actinic keratosis on the forehead, upper trunk and on the left cheek. In addition, an exulcerated basal cell carcinoma was observed. The patient was advised only to treat lesions on the forehead with imiquimod cream. This resulted in complete clearance of actinic keratosis within 6 weeks. At follow-up, a planned surgical excision of the basal cell carcinoma and actinic keratosis on the cheek was carried out. Histopathologically, both excision specimens no longer showed features of basal cell carcinoma or actinic keratosis, despite the fact that the imiquimod treatment was not applied to the cheek. Imiquimod cream is a topical immune response modifier, which has shown antiviral and anti-tumorous properties by inducing the production of cytokines as well as by stimulating dendritic cells and lymphocytes. Our observation supports the concept of lymphatic transport of immune cells and factors with subsequent immunological curing of tumours, not only in the treated area, but also those in the area between the imiquimod application site and the regional lymph nodes (the "lymphatic field clearance").
基底细胞癌和光化性角化病是常见的肿瘤。局部治疗包括最近批准的咪喹莫特乳膏。我们在此描述了一位 68 岁男性的病例，他的前额、上半身和左脸颊有多发性光化性角化病。此外，还观察到一处溃疡性基底细胞癌。患者仅被建议在前额用咪喹莫特乳膏治疗病变。结果，6 周内完全清除了光化性角化病。随访时，计划对脸颊处的基底细胞癌和光化性角化病进行手术切除。组织病理学检查显示，尽管咪喹莫特乳膏未用于脸颊，但两个切除标本均不再显示基底细胞癌或光化性角化病的特征。咪喹莫特乳膏是一种局部免疫反应调节剂，通过诱导细胞因子的产生以及刺激树突状细胞和淋巴细胞，显示出抗病毒和抗肿瘤特性。我们的观察结果支持免疫细胞和因子经淋巴转运的概念，随后对肿瘤进行免疫治疗，不仅在治疗区域，而且在咪喹莫特应用部位和区域淋巴结之间的区域（“淋巴场清除”）也能进行免疫治疗。
