Safety and efficacy of imiquimod 5% cream for the treatment of bowen's disease

Topical imiquimod

In this ever-expanding world of immunologic advancements, Drs Langley and Pearson have undertaken this timely, succinct review of imiquimod. Given its direct actions on monocytes and macrophages, as well as the many diverse cytokine effects that follow from these events, topical imiquimod has already solidly established itself as a successful treatment for condylomata and molluscum, and will likely show continued therapeutic applications in the future.

Imiquimod: a novel treatment for lentigo maligna

Lentigo maligna is the in situ phase of lentigo maligna melanoma, and if left untreated it may progress to invasive melanoma. It most commonly occurs on the exposed sites of the face and neck of middle-aged or elderly patients. Conventional surgery using a 5-10 mm margin is the recommended treatment; however, lesions can be quite large and surgical removal may involve extensive plastic repair. We report an elderly patient with a large lentigo maligna on the scalp who was reluctant to have surgery. We tried topical imiquimod 5% cream (Aldara), a local immunomodulator, which has recently become available for the treatment of external genital and perianal warts. Initially used over a test area and then over the whole of the lesion, for a total of 7 months, the imiquimod cream resulted in complete clinical and histological cure. The patient has been followed up for 9 months without evidence of recurrence.