A randomized trial of the off-label use of imiquimod, 5%, cream with vs without
tazarotene, 0.1%, gel for the treatment of lentigo maligna, followed by
conservative staged excisions.
Author(s): Hyde MA, Hadley ML, Tristani-Firouzi P, Goldgar D, Bowen GM.
Affiliation(s): Department of Dermatology, The University of Utah, Salt Lake City, UT 84112, USA.
Mark.hyde@hci.utah.edu
Publication date & source: 2012, Arch Dermatol. , 148(5):592-6
OBJECTIVE: To determine if the complete response rates of lentigo maligna (LM) to
imiquimod, 5%, cream can be improved by the addition of a topical retinoid.
DESIGN: Prospective randomized study of patients treated with imiquimod alone vs
imiquimod plus a topical retinoid, followed by conservative staged excisions.
SETTING: Mohs surgical clinic in an academic institution.
PATIENTS: Ninety patients with biopsy-confirmed LM.
INTERVENTIONS: Ninety patients with 91 LMs were randomized into 2 groups. One
group received imiquimod, 5%, cream 5 d/wk for 3 months, while the other group
also received tazarotene, 0.1%, gel 2 d/wk for 3 months. Following topical
therapy, all patients underwent staged excisions and frozen section analysis with
Melan-A immunostaining to confirm negative margins.
MAIN OUTCOME MEASURE: The presence or absence of residual LM at the time of
staged excision. Results: Forty-six patients with 47 LMs were randomized to
receive monotherapy: 42 of 47 LMs reached the intended treatment duration, with
27 complete responses (64%). Forty-four patients with 44 LMs were randomized to
receive combined therapy: 37 of 44 LMs reached the intended treatment duration,
with 29 complete responses (78%). This difference did not reach statistical
significance (P=.17). There have been no recurrences to date, with a mean
follow-up period of 42 months.
CONCLUSIONS: Among patients who received topical imiquimod with vs without
tazarotene, 22% (8 of 37) of lesions vs 36% (15 of 42) of lesions showed residual
LM on staged excisions. Pretreating LM with imiquimod, 5%, cream may decrease
surgical defect sizes; however, total reliance on topical imiquimod as an
alternative to surgery may put the patient at increased risk of a local
recurrence.
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