RT Journal
A1 Ly L, Kelly J, O ’Keefe R, et al
T1 Efficacy of imiquimod cream, 5%, for lentigo maligna after complete excision: A study of 43 patients
JF Archives of Dermatology
JO Archives of Dermatology
YR 2011
FD October 1
VO 147
IS 10
SP 1191
OP 1195
DO 10.1001/archdermatol.2011.260
UL http://dx.doi.org/10.1001/archdermatol.2011.260
AB Objective 
                  To determine the efficacy of imiquimod cream, 5%, in the treatment of lentigo maligna (LM).Design 
                  Open-label before-and-after interventional study.Setting 
                  A multidisciplinary melanoma clinic at a major tertiary hospital.Patients 
                  Forty-three patients with biopsy-proven LM of greater than 5 mm in diameter completed this study.Interventions 
                  Imiquimod cream, 5%, was applied to the lesion 5 days a week for 12 weeks. The original lesion was excised with a 5-mm margin.Main Outcome Measures 
                  The primary outcome was histopathologic evidence of LM in the excision specimen assessed independently by 2 of 3 dermatopathologists. Visible inflammation during treatment and macroscopic clearance were recorded.Results 
                  When 5 of the 43 patients with discordant histopathologic assessment of the excision specimen were excluded, 20 of 38 patients (53% [95% confidence interval, 36%-69%]) demonstrated histopathologic clearance of LM after imiquimod treatment. Visible inflammation was significantly associated with histopathologic clearance (P  =  .04), but the positive predictive value was low (62%). Macroscopic clearance showed some association with histopathologic clearance (P  =  .11). Dermatopathologist concordance for all 43 specimens was substantial ( κ  =  0.77; 95% confidence interval, 0.57-0.96).Conclusions 
                  Imiquimod cream, 5%, has limited efficacy in the treatment of LM when determined by histopathologic assessment of the entire treated area. The clinical signs of visible inflammation during treatment and apparent lesion clearance cannot be relied on to assess efficacy.Trial Registration 
                  anzctr.org.au Identifier:  ACTRN12610000066088