Tio D, van der Woude J, Prinsen C A C, Jansma E P, Hoekzema R, van Montfrans C
Department of Dermatology, VUmc Amsterdam, Amsterdam, The Netherlands.
Flevoziekenhuis Almere, Almere, The Netherlands.
J Eur Acad Dermatol Venereol. 2017 Apr;31(4):616-624. doi: 10.1111/jdv.14085. Epub 2017 Jan 23.
Lentigo maligna (LM) is an in situ variant of melanoma. Our objective was to systematically review clinical and histological clearance and recurrence rates of imiquimod treatment of LM with emphasis on progression to lentigo maligna melanoma (LMM). PubMed, EMBASE and the Cochrane library were searched from inception to May 2015. Articles were included if they described histologically proven LM treated with imiquimod 5% monotherapy or combined with another topical therapy. Analysed outcomes were clinical and histological clearance, recurrence rates and number of LMM. The quality was assessed using the GRADE-like checklist, and results were reported according to the PRISMA Statement. Twenty-six case reports, 11 retrospective studies, three prospective studies and one randomized controlled trial were included. One case report of poor quality was excluded. Complete clinical clearance was seen in 369 of 471 patients (78.3%). Histological clearance was present in 285 of 370 (77%) patients. LMM was diagnosed in nine (1.8%) patients 3.9 months (range 0-11 months) post-treatment. Univariate multinominal logistic regression showed that 6-7 applications/week had a 6.47 greater odds (P = 0.017) of resulting in complete clinical clearance compared to 1-4 applications/week. An intensity of 6-7 applications/week showed a 8.85 greater odds (P = 0.003) of resulting in histological clearance compared to 1-4 applications. Applying imiquimod >60 times during a treatment period of 12 weeks (range 4-36) showed a 7.75 greater odds (P = 0.001) of resulting in histological clearance compared to <60 total applications. In conclusion, a treatment schedule using imiquimod 6-7 applications per week, with at least 60 applications, shows the greatest odds of complete clinical and histological clearance of LM. Imiquimod is an option for patients unfit for or not willing to undergo surgery or radiotherapy. Nine cases of LM progressed to LMM shortly after treatment. Our hypothesis is that these LMM may have been present before starting imiquimod.
恶性雀斑样痣（LM）是黑色素瘤的一种原位变体。我们的目的是系统回顾咪喹莫特治疗LM的临床和组织学清除率及复发率，重点关注其进展为恶性雀斑样痣黑色素瘤（LMM）的情况。检索了从创刊至2015年5月的PubMed、EMBASE和Cochrane图书馆。如果文章描述了经组织学证实的用5%咪喹莫特单药治疗或联合其他局部治疗的LM，则纳入研究。分析的结果包括临床和组织学清除、复发率以及LMM的病例数。使用类似GRADE的清单评估质量，并根据PRISMA声明报告结果。纳入了26篇病例报告、11项回顾性研究、3项前瞻性研究和1项随机对照试验。排除了1篇质量较差的病例报告。471例患者中有369例（78.3%）实现了完全临床清除。370例患者中有285例（77%）实现了组织学清除。9例（1.8%）患者在治疗后3.9个月（范围0 - 11个月）被诊断为LMM。单因素多项逻辑回归显示，与每周1 - 4次应用相比，每周6 - 7次应用实现完全临床清除的几率高6.47倍（P = 0.017）。与每周1 - 4次应用相比，每周6 - 7次应用实现组织学清除的几率高8.85倍（P = 0.003）。在12周（范围4 - 36周）的治疗期内应用咪喹莫特>60次与总应用次数<60次相比，实现组织学清除的几率高7.75倍（P = 0.001）。总之，每周应用咪喹莫特6 - 7次、至少应用60次的治疗方案实现LM完全临床和组织学清除的几率最高。咪喹莫特是不适合或不愿意接受手术或放疗患者的一种选择。9例LM在治疗后不久进展为LMM。我们的假设是这些LMM可能在开始使用咪喹莫特之前就已存在。
