Savarese I, Papi F, D'Errico A, Gori A, Grazzini M, Vannucchi M, Massi D, De Giorgi V
Department of Dermatology, University of Florence, Florence, Italy.
Clin Exp Dermatol. 2015 Jan;40(1):27-30. doi: 10.1111/ced.12469. Epub 2014 Sep 23.
An 85-year-old woman presented with a lesion on the sole of her right foot, which was histologically confirmed as acral lentiginous melanoma. Because of the large field involved and because the patient refused any invasive or painful treatment, topical treatment with imiquimod was commenced. At the 20-month follow-up, the patient was still continuing treatment with topical imiquimod, and no metastases to the lymph nodes or viscera were found, either clinically or in imaging studies. We believe that the success of the treatment cannot be explained only by the stimulation of the immune system induced by imiquimod. A possible explanation might be 'tumour dormancy', where a tumour grows very slowly because of a balance between the neoplasia and the immune (and nonimmune) mechanisms of tumour control. The use of imiquimod has so far allowed our patient to avoid surgery, and perturbation of the mechanisms of tumour regulation, such as local immunity and angiogenesis, has not taken place.
一名85岁女性因右脚脚底出现病变就诊，组织学检查确诊为肢端雀斑样痣黑素瘤。由于病变范围较大且患者拒绝任何侵入性或痛苦的治疗，遂开始使用咪喹莫特进行局部治疗。在20个月的随访中，患者仍在继续使用咪喹莫特进行局部治疗，临床及影像学检查均未发现淋巴结或内脏转移。我们认为，治疗的成功不能仅用咪喹莫特诱导的免疫系统刺激来解释。一种可能的解释或许是“肿瘤休眠”，即肿瘤由于肿瘤形成与肿瘤控制的免疫（和非免疫）机制之间的平衡而生长非常缓慢。迄今为止，咪喹莫特的使用使我们的患者避免了手术，且尚未发生肿瘤调节机制（如局部免疫和血管生成）的紊乱。
