[Translated article] Update on Lentigo Maligna: Diagnostic Signs and Treatment

Lentigo maligna is an in situ cutaneous melanoma that arises in sun-damaged skin. Its most common presentation is a progressive, slow-growing, irregularly pigmented spot on the face of older patients. Although the exact percentage of lentigo maligna that progresses to invasive tumors is unknown, it is thought to lie between 2% and 5%. Both the clinical and histologic diagnosis of lentigo maligna can be challenging, especially in patients with early-stage or atypical disease. Treatment also holds challenges, because lesions are located in highly visible areas and are often large. Surgery can thus compromise cosmetic and sometimes functional outcomes. We review clinical and histopathological findings that can facilitate the diagnosis of lentigo maligna. We also examine treatment options, with a focus on surgery.     

Case of large lentigo maligna melanoma of the scalp treated with 5% and 3.75% Imiquimod

The paper presents a case of lentigo maligna melanoma of the scalp in an elderly patient treated for the nodular part with surgery and the residual melanoma in situ with 5% Imiquimod and subsequently with 3.75% Imiquimod (each concentration for 4 months, 5 times per week), with complete regression of the lesion. 3.75% Imiquimod, which is already used for the treatment of actinic keratosis, could be a useful weapon with the same effectiveness and fewer side effects compared to 5% Imiquimod.     

Simultaneous occurrence of multiple melanoma in situ on sundamaged skin (lentigo maligna), solar lentigo and labial melanosis: the value of dermoscopy in diagnosis

We report on a patient developing simultaneous occurrence of lentigo maligna lesions, solar lentigines and an extensive melanosis of the oral mucosa. Diagnostically, epiluminescence microscopy had a relevant role in the preoperative assessment and selection of suspicious pigmented lesions, as the lesions histologically labelled as lentigo maligna and solar lentigo were clinically indistinguishable. We review the clinical, dermoscopic and histopathologic differential diagnosis of solar lentigo, malignant lentigo and mucosal melanosis with other melanocytic and keratinocytic lesions and discuss the possible relationship between these entities.     

5%咪喹莫特乳膏治疗尖锐湿疣的多中心、随机双盲、对照研究

目的评价5%咪喹莫特乳膏治疗尖锐湿疣的疗效和安全性,并与2.5%5-氟脲嘧啶乳膏进行对照。方法对尖锐湿疣患者进行多中心、随机双盲、平行对照的临床试验研究。5%咪喹莫特乳膏试验组和2.5%5-氟脲嘧啶乳膏对照组均每周外用药物3次,共治疗8周。结果本研究共244例患者完成全部观察,其中,咪喹莫特组125例,5-氟脲嘧啶组119例。咪喹莫特组治疗后2、4、6、8周的痊愈率分别为52.00%、74.40%、81.60%、92.80%、有效率分别为79.20%、93.60%、97.60%、97.60%.5-氟脲嘧啶组治疗后2、4、6、8周的痊愈率分别为52.10%、70.59%,78.15%、89.92%、有效率分别为84.03%、94.12%、94.96%、97.48%。两组差异均无统计学意义(P>0.05)。不良事件主要为局部不良反应,如局部红斑、疼痛、糜烂,瘙痒等,未见系统性不良反应。结论5%咪喹莫特乳膏治疗尖锐湿疣疗效确切,使用方法简便,耐受性较好。     

An Open, Randomized, Comparative Clinical and Histological Study of Imiquimod 5% Cream Versus 10% Potassium Hydroxide Solution in the Treatment of Molluscum Contagiosum

Background

Although molluscum contagiosum (MC) resolves spontaneously, there are several reasons to treat this dermatological disorder.

Objective

To evaluate the safety and efficacy of 5% imiquimod cream versus 10% potassium hydroxide (KOH) solution in treating MC, and to propose the mechanism of cure by observing the histological findings.

Methods

Imiquimod or KOH were applied by the patient or a parent 3 days per week until all lesions cleared. The number of MC lesions was counted and side effects were evaluated at 5 points during the treatment (the initial visit, week 2, week 4, week 8, and week 12). Histological changes were compared between 2 patients of each group, before and after the 2 weeks of application.

Results

In both group, the mean lesion counts decreased all through to week 12, and the reduction in number of lesions were statistically significant in both groups (p <0.005). Over 40% of each group developed local side effects, and no systemic side effects were noted in either group. Before treatment, histological findings showed little or no dermal infiltrates. After treatment, specimens showed dense lymphocytic infiltrates, especially T cells, around the lesions which had resolved.

Conclusion

Both 10% KOH solution and 5% imiquimod cream are effective and safe treatment of MC.     

Psoriasiform Eruption and Oral Ulcerations as Adverse Effects of Topical 5% Imiquimod Treatment in Children: A Report of Four Cases

Abstract: Imiquimod 5% cream is a topical immune‐response modifier indicated in the treatment of multiple cutaneous conditions including actinic keratoses, superficial basal cell carcinoma, and condylomata acuminata. In children, it has been approved only for ages 12 and older in the treatment of external genital and perianal warts. It has also been used off label for a variety of pediatric skin disorders, including molluscum contagiosum (MC), trichoepitheliomas, verrucae plana, and verrucae vulgaris. Local and systemic adverse reactions have been reported, with the most frequently reported events being application site reactions including itching, burning, erythema, and erosion. Although these local reactions are well known, other rare local and systemic reactions can occur. There have been multiple case reports in adults of rare adverse cutaneous reactions occurring with imiquimod, but few have been reported in children. We present four cases of rare adverse cutaneous reactions. In all cases, the children were being treated with imiquimod 5% cream for verrucae or MC. Two of these patients developed a localized psoriasiform eruption, and two developed mucosal ulcerations.