The successful treatment of 6 cases of lentigo maligna (LM) with topical imiquimod was recently reported by Wolf et al.1 We describe a 78-year-old woman with an extensive recurrent LM (melanoma in situ) that completely regressed after 12 weeks of topical imiquimod therapy. Dermoscopic analysis was useful to confirm the initial diagnosis and to monitor treatment efficacy.
The recently described dermoscopic features of facial LM have proved crucial to differentiate LM from solar lentigo (lentigo senilis), seborrheic keratosis, lichen planus–like keratosis, and pigmented actinic keratosis.2 Characteristic dermoscopic features of early-phase LM are asymmetrical pigmented follicular openings, slate-gray dots and globules aggregated around hair follicles, and short brown or black streaks. Disease progression is characterized by the appearance of long and intersected streaks that form rhomboidal structures around the follicles, clearly visible annular-granular structures due to the confluence of dots and globules, and homogeneous areas.2 Dermoscopy has been also shown to enhance the diagnostic accuracy of determining the clinical borders of LM lesions and to guide the margin of resection.3
Clinical appearance of lentigo maligna before (A) and after (B) 12 weeks of 5% imiquimod therapy.
Dermoscopic images obtained before and after 6 and 12 weeks of treatment with 5% imiquimod. A, Before treatment, asymmetrical pigmented follicular openings (arrowhead) and annular-granular (white arrow) and rhomboidal (black arrow) structures are clearly visible around the follicular openings. B, After 6 weeks of treatment, a reduction of the annular-granular and rhomboidal structures is observed. C, After 12 weeks of treatment, there is a complete absence of the dermoscopic structures that are characteristic of lentigo maligna.
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