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Journal of the American Academy of Dermatology
Volume 71, n° 1
pages 49-55 (juillet 2014)
Doi : 10.1016/j.jaad.2014.02.043
accepted : 27 February 2014
Original Articles

In vivo reflectance confocal microscopy to monitor the response of lentigo maligna to imiquimod

Ivette Alarcon, MD a, b, Cristina Carrera, MD a, b, c, Llucia Alos, MD d, e, Josep Palou, MD d, Josep Malvehy, MD, PhD a, b, c, Susana Puig, MD, PhD a, b, c, e,
a Dermatology Department, Melanoma Unit, Hospital Clinic of Barcelona, Barcelona, Spain 
d Pathology Department, Melanoma Unit, Hospital Clinic of Barcelona, Barcelona, Spain 
b Institut de Recerca Biomédica August Pi i Sunyer (IDIBAPS), Barcelona, Spain 
c Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain 
e Universitat de Barcelona, Barcelona, Spain 

Reprint requests: Susana Puig, MD, PhD, Dermatology Department, Melanoma Unit, Hospital Clinic Barcelona, Villarroel 170, 08036 Barcelona, Spain.

Imiquimod has been used for treating lentigo maligna (LM) in selected cases when surgery is not an appropriate option because of functional or aesthetic impairment. Reflectance confocal microscopy (RCM) is a noninvasive method that has not been validated for monitoring the treatment of LM with imiquimod.


We sought to evaluate the use of in vivo RCM to accurately monitor the response of LM to nonsurgical treatment with topical imiquimod.


Twenty patients with confirmed facial LM, not amenable to surgical treatment or radiation therapy, were included prospectively. Clinical evaluation was performed by dermoscopy, RCM, and histopathology. Patients applied imiquimod 5% for 8 weeks. The affected area was assessed using the previously described LM score on RCM, and target sample biopsies were performed to confirm or discard RCM findings.


Fifteen of the 20 patients (75%) presented histologic tumor clearance. Confocal microscopy identified 70% of these responders with no false-negative results, and when compared with histopathology, there was no significant difference in evaluating the response to imiquimod.


The impossibility of examining the entire lesion by means of histopathology is a limitation.


In vivo RCM evaluation was useful in accurately monitoring the response of LM to nonsurgical treatment with topical imiquimod in patients when surgery is contraindicated.

The full text of this article is available in PDF format.

Key words : dermoscopy, imiquimod, lentigo maligna, melanoma, noninvasive diagnosis, nonsurgical treatment, reflectance confocal microscopy

 The research at the Melanoma Unit in Barcelona is partially funded by grants 09/1393 and 12/00840 from Fondo de Investigaciones Sanitarias, Spain; by the Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Raras of the Instituto de Salud Carlos III, Spain, cofunded by “Fondo Europeo de Desarrollo Regional, Unión Europea, Una manera de hacer Europa”; by the Agència de Gestió d'Ajuts Universitaris i de Recerca (AGAUR) 2009 SGR 1337 of the Catalan Government, Spain; by the European Commission under the Sixth Framework Programme, Contract no. LSHC-CT-2006-018702 (GenoMEL); and by the National Cancer Institute of the US National Institutes of Health (CA83115). The sponsors had no role in the design and conduct of the study; in the collection, analysis, and interpretation of data; or in the preparation, review, or approval of the manuscript.
 Conflicts of interest: None declared.

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