咪喹莫特 5%乳膏作为原位黑素瘤、恶性雀斑样痣型的一线或辅助治疗药物。
Imiquimod 5% cream as primary or adjuvant therapy for melanoma in situ, lentigo maligna type.
机构信息
Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, California.
Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, California.
出版信息
J Am Acad Dermatol. 2015 Jun;72(6):1047-53. doi: 10.1016/j.jaad.2015.02.008. Epub 2015 Mar 17.
BACKGROUND
Surgical resection of lentigo maligna (LM) is complicated by noncontiguous, subclinical extension and actinic melanocytic hyperplasia in sun-damaged skin of older individuals.
OBJECTIVE
We sought to determine the long-term effectiveness of imiquimod as primary or adjuvant therapy for LM.
METHODS
Patients were retrospectively identified from January 1, 2003, to December 31, 2013, with LM, early/evolving LM, and LM melanoma who had used topical imiquimod 5% cream for either primary therapy after diagnostic biopsy, or adjuvant therapy after narrow-margin surgical resection or complete clinical but not histologic resection of LM. Follow-up occurred through December 31, 2014.
RESULTS
In all, 63 cases were identified in 61 patients, mean (SD) age 71.1 (12.4) years; 58 were analyzed for local recurrence. Imiquimod was used as primary therapy in 22 of 63 (34.9%) and adjuvant therapy in 41 of 63 (65.1%) for mean duration of 11.7 (range 2-60) weeks. Fifty cases (86.2%) demonstrated clinical clearance at mean (SD) follow-up of 42.1 (27.4) months: 72.7% primary and 94.4% adjuvant at 39.7 (23.9) and 43.1 (28.9) months, respectively.
LIMITATIONS
Retrospective cohort study and lack of standardized imiquimod application are limitations.
CONCLUSION
Imiquimod cream appears to be a viable option for primary or adjuvant treatment of LM in older patients who are poor surgical candidates.
背景
由于在老年日光损伤皮肤中存在非连续的、亚临床的扩展和光化性黑素细胞增生，手术切除交界痣（LM）较为复杂。
目的
我们旨在确定咪喹莫特作为 LM 的初始或辅助治疗的长期有效性。
方法
2003 年 1 月 1 日至 2013 年 12 月 31 日，我们对患有 LM、早期/进展期 LM 和 LM 黑色素瘤的患者进行了回顾性研究，这些患者在诊断性活检后使用咪喹莫特 5%乳膏进行初始治疗，或在窄切缘手术切除后或 LM 的完全临床但非组织学切除后进行辅助治疗。随访时间截止到 2014 年 12 月 31 日。
结果
共在 61 例患者中识别出 63 例（61 例患者中有 63 例），平均（SD）年龄 71.1（12.4）岁；58 例进行了局部复发分析。咪喹莫特在 63 例中的 22 例（34.9%）中作为初始治疗，在 63 例中的 41 例（65.1%）中作为辅助治疗，平均持续时间为 11.7（范围 2-60）周。50 例（86.2%）在平均（SD）随访 42.1（27.4）个月时显示出临床清除：39.7（23.9）个月时初始治疗的 72.7%和辅助治疗的 94.4%，以及 43.1（28.9）个月时初始治疗的 72.7%和辅助治疗的 94.4%。
局限性
回顾性队列研究和缺乏标准化的咪喹莫特应用是局限性。
结论
咪喹莫特乳膏似乎是老年患者 LM 的初始或辅助治疗的可行选择，这些患者不适合手术治疗。
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