Fan Qing, Cohen Stephanie, John Becky, Riker Adam I
General & Oncology Surgery Departments, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
Department of Surgery, Advocate Cancer Institute, Advocate Christ Medical Center, Oak Lawn, IL.
Ochsner J. 2015 Winter;15(4):443-7.
Imiquimod is a topical cream approved by the US Food and Drug Administration for treatment of superficial basal cell carcinoma, actinic keratosis, and genital-perianal warts. Its successful use in patients with persistently positive margins of melanoma in situ (MIS) after surgical excision has been previously reported.
A 75-year-old female presented with a primary melanoma that was removed through an elliptical excision with 1 cm margins. Pathology revealed 3 involved margins with residual MIS without an invasive component. After a second operation removed an additional 1 cm margin, pathology revealed 2 positive margins with residual MIS. Rather than undergoing a third excision, the patient decided to pursue a nonsurgical approach with topical imiquimod, and at the 4-month follow-up examination, the incision was completely healed with no clinical evidence of tumor recurrence.
A nonsurgical approach with 5% topical imiquimod cream applied along the incision was utilized. In specific patient populations, the use of imiquimod is a reasonable alternative approach for the management of persistently positive MIS margins. Long-term follow-up is necessary to assess for evidence of recurrence and the ultimate success of this nonsurgical approach.
咪喹莫特是一种经美国食品药品监督管理局批准用于治疗浅表基底细胞癌、光化性角化病和生殖器肛周疣的外用乳膏。此前已有报道称其在手术切除后原位黑色素瘤（MIS）边缘持续阳性的患者中成功应用。
一名75岁女性，患有原发性黑色素瘤，通过边缘为1厘米的椭圆形切除术切除。病理显示3个切缘受累，有残余MIS，无浸润成分。二次手术后再切除1厘米边缘，病理显示2个切缘阳性，有残余MIS。该患者未进行第三次切除，而是决定采用外用咪喹莫特的非手术方法，在4个月的随访检查中，切口完全愈合，无肿瘤复发的临床证据。
采用沿切口涂抹5%外用咪喹莫特乳膏的非手术方法。在特定患者群体中，使用咪喹莫特是处理MIS边缘持续阳性的一种合理替代方法。需要长期随访以评估复发证据和这种非手术方法的最终成功率。
