Confocal Microscopy and Lentigo Maligna: An in vivo Pilot Study for the Assessment of Response to Imiquimod Therapy.
Adult
Aged
Aged, 80 and over
Antineoplastic Agents
/ therapeutic use
Contraindications, Procedure
Dermatologic Surgical Procedures
/ adverse effects
Dermoscopy
Female
Head and Neck Neoplasms
/ diagnostic imaging
Humans
Hutchinson's Melanotic Freckle
/ diagnostic imaging
Imiquimod
/ therapeutic use
Male
Microscopy, Confocal
Middle Aged
Neoplasm Recurrence, Local
/ diagnostic imaging
Pilot Projects
Skin Neoplasms
/ diagnostic imaging
Treatment Outcome
Imiquimod therapy
Lentigo maligna
Noninvasive follow-up
Reflectance confocal microscopy
Journal
Dermatology (Basel, Switzerland)
ISSN: 1421-9832
Titre abrégé: Dermatology
Pays: Switzerland
ID NLM: 9203244
Informations de publication
Date de publication:
2019
2019
Historique:
received:
24
09
2018
accepted:
01
11
2018
pubmed:
17
12
2018
medline:
14
6
2019
entrez:
17
12
2018
Statut:
ppublish
Résumé
Reflectance confocal microscopy (RCM) is a noninvasive technique that provides real-time in vivo images of the epidermal layer. Imiquimod has been recommended as an alternative treatment in lentigo maligna (LM) when surgical excision is not the treatment of choice. In the present study we compare the results of in vivo RCM to the histopathological examination before and after treatment of LM with topical imiquimod. Thirty-four patients with confirmed LM were included. Imiquimod 5% was applied until a weeping erosion appeared in the LM-affected skin. Evaluation was performed by clinical examination, dermatoscopy, histopathology and RCM. During the follow-up, 27 of 34 patients (79.42%) demonstrated a total tumor clearance by imiquimod treatment. In the treated area, a significant decrease of atypical cells was detected using RCM (p < 0.0001). Furthermore, a significant positive correlation in the detected atypical cells was shown using confocal microscopy and histology (p = 0.0001, r = 0.7335, respectively). In patients not suitable for surgical intervention imiquimod treatment is an appropriate treatment alternative. Thereby, in vivo RCM was demonstrated to be an excellent examining device, which not only allows diagnosis of LM, but also therapy and follow-up examinations. An important benefit of RCM, in contrast to conventional histopathology, is the simple handling with in vivo examination of epidermal skin without any pain for the patient.
Sections du résumé
BACKGROUND
BACKGROUND
Reflectance confocal microscopy (RCM) is a noninvasive technique that provides real-time in vivo images of the epidermal layer. Imiquimod has been recommended as an alternative treatment in lentigo maligna (LM) when surgical excision is not the treatment of choice. In the present study we compare the results of in vivo RCM to the histopathological examination before and after treatment of LM with topical imiquimod.
METHODS
METHODS
Thirty-four patients with confirmed LM were included. Imiquimod 5% was applied until a weeping erosion appeared in the LM-affected skin. Evaluation was performed by clinical examination, dermatoscopy, histopathology and RCM.
RESULTS
RESULTS
During the follow-up, 27 of 34 patients (79.42%) demonstrated a total tumor clearance by imiquimod treatment. In the treated area, a significant decrease of atypical cells was detected using RCM (p < 0.0001). Furthermore, a significant positive correlation in the detected atypical cells was shown using confocal microscopy and histology (p = 0.0001, r = 0.7335, respectively).
CONCLUSION
CONCLUSIONS
In patients not suitable for surgical intervention imiquimod treatment is an appropriate treatment alternative. Thereby, in vivo RCM was demonstrated to be an excellent examining device, which not only allows diagnosis of LM, but also therapy and follow-up examinations. An important benefit of RCM, in contrast to conventional histopathology, is the simple handling with in vivo examination of epidermal skin without any pain for the patient.
Identifiants
pubmed: 30554198
pii: 000495034
doi: 10.1159/000495034
doi:
Substances chimiques
Antineoplastic Agents
0
Imiquimod
P1QW714R7M
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
150-155Informations de copyright
© 2018 S. Karger AG, Basel.