Department of Dermatology, University of Colorado, Aurora, Colorado 80045, USA.
Dermatol Surg. 2012 Jun;38(6):937-46. doi: 10.1111/j.1524-4725.2012.02362.x. Epub 2012 Feb 16.
The standard of care for melanoma in situ (MIS) is surgical removal by surgical excision with a 5-mm margin or Mohs micrographic surgery, but as more and more MIS is diagnosed in the head and neck region, surgeries may not be an option for patients when the lesions are large or less well defined. In addition, when negative margins cannot be achieved without grossly disfiguring the patient or when patients have medical comorbidities that preclude a surgical option, other treatment modalities may be considered. Recently, topical treatment with an immunomodulator, imiquimod, has been proposed as an alternative treatment for MIS.
We report a case of MIS successfully treated with topical imiquimod cream. In addition, because there has not been any comprehensive review of the use of topical imiquimod on melanoma and MIS, we conducted an extensive literature search and reviewed the topic in detail.
Using the keywords "imiquimod," "melanoma," "melanoma-in-situ," and "lentigo maligna," we searched the literature using PubMed in an attempt to find all relevant articles on the use of imiquimod on MIS or melanoma.
There were 46 reports involving 264 patients on the use of imiquimod on MIS or lentigo maligna. Twenty-three reports were published on the use of imiquimod on metastatic melanoma involving 55 patients, and two articles were on melanoma, with two patients in total. In addition, there were two articles on the use of imiquimod on dysplastic or atypical nevi with a total of 13 subjects.
Imiquimod appears to be beneficial in the treatment of MIS and melanoma metastases when surgical options are not feasible. Imiquimod should not be used for removal of dysplastic or atypical nevi. The treatment regimens varied from study to study, and there are no randomized controlled trials in the literature. More studies are needed to develop a reliable and reproducible treatment regimen, to fully elucidate the role of imiquimod in the treatment of MIS and melanoma, and to determine the prognostic predictors for favorable responses to imiquimod.
对于原位黑色素瘤（MIS），标准治疗方法是手术切除，切除范围为 5mm 边界或 Mohs 显微外科手术，但随着越来越多的 MIS 被诊断为头颈部区域，当病变较大或定义不明确时，手术可能不是患者的选择。此外，当无法在不严重毁容患者的情况下获得阴性切缘，或者当患者有医学合并症而无法选择手术时，可能会考虑其他治疗方法。最近，局部应用免疫调节剂咪喹莫特已被提议作为 MIS 的替代治疗方法。
我们报告了一例成功用咪喹莫特乳膏治疗的 MIS。此外，由于尚未对咪喹莫特在黑色素瘤和 MIS 中的应用进行全面综述，我们进行了广泛的文献检索，并详细回顾了该主题。
使用关键词“咪喹莫特”、“黑色素瘤”、“原位黑色素瘤”和“恶性雀斑样痣”，我们在 PubMed 上进行了文献搜索，试图找到所有关于咪喹莫特在 MIS 或黑色素瘤中的应用的相关文章。
有 46 份报告涉及 264 例咪喹莫特治疗 MIS 或恶性雀斑样痣的患者。有 23 份报告发表于咪喹莫特治疗转移性黑色素瘤的 55 例患者，有 2 篇文章涉及黑色素瘤，共 2 例患者。此外，有两篇文章涉及咪喹莫特治疗发育不良或非典型痣，共涉及 13 例患者。
当手术选择不可行时，咪喹莫特似乎对 MIS 和黑色素瘤转移的治疗有益。咪喹莫特不应用于去除发育不良或非典型痣。治疗方案因研究而异，文献中没有随机对照试验。需要更多的研究来制定可靠和可重复的治疗方案，充分阐明咪喹莫特在 MIS 和黑色素瘤治疗中的作用，并确定对咪喹莫特治疗有良好反应的预后预测因素。
