Institute of Dermatology, Università Cattolica del Sacro Cuore, Rome, Italy.
Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy.
Int J Dermatol. 2021 Feb;60(2):196-200. doi: 10.1111/ijd.15070. Epub 2020 Jul 25.
In recent years, there has been an ongoing interest in topical treatment for lentigo maligna (LM) as imiquimod 5% cream owing to the localization of this tumor and the advanced age of patients; however, the efficacy of imiquimod 5% cream is controversial, and the rate of local relapses is about 25-53%. Reflectance confocal microscopy (RCM) is a noninvasive diagnostic tool useful not only for diagnostic purpose but also for monitoring the response to the local treatment of LM. Our aim was to demonstrate the role of RCM in the follow-up of a topical treatment with imiquimod 5% cream in clinical practice.
We report three patients with histopathologically confirmed LM who were not candidates for surgery and were successfully treated with imiquimod 5% cream. In such patients, dermatoscopic images and reflectance confocal microscopy were useful to evaluate treatment response and to verify long-term clinical benefits during the follow-up visits.
No relapses were observed in our patients 18 months after the end of treatment; although, continuous follow-up visits are needed in these patients.
In the case series presented herein, we highlight the importance of RCM as a noninvasive tool to monitor the efficacy of imiquimod to treat LM during and after treatment. Detailed confocal images of two of our patients allowed us to establish the persistence of atypical cells and to continue treatment, although clinical and dermatoscopic examinations showed "apparent complete remission" after the first cycle of therapy.
近年来，由于肿瘤的定位和患者的高龄，咪喹莫特 5%乳膏等局部治疗方法一直受到关注；然而，咪喹莫特 5%乳膏的疗效存在争议，局部复发率约为 25-53%。反射共聚焦显微镜（RCM）是一种非侵入性诊断工具，不仅可用于诊断目的，还可用于监测局部治疗 LM 的反应。我们的目的是证明 RCM 在临床实践中对咪喹莫特 5%乳膏局部治疗的随访中的作用。
我们报告了 3 例经组织病理学证实的 LM 患者，他们不适合手术治疗，成功地接受了咪喹莫特 5%乳膏治疗。在这些患者中，皮肤镜图像和反射共聚焦显微镜有助于评估治疗反应，并在随访期间验证长期临床获益。
治疗结束后 18 个月，我们的患者均未复发；然而，这些患者仍需要持续随访。
在本病例系列中，我们强调了 RCM 作为一种非侵入性工具的重要性，可用于监测咪喹莫特治疗 LM 的疗效，包括治疗期间和治疗后。我们的两位患者的详细共聚焦图像使我们能够确定异常细胞的持续存在，并继续治疗，尽管临床和皮肤镜检查显示在第一个治疗周期后出现“明显完全缓解”。
