El lentigo maligno es una lesión melanocítica in situ cuyo objetivo primario es la extirpación completa. Este protocolo se aplica cuando el enfoque quirúrgico de primera línea no ha alcanzado el objetivo previsto, o cuando la cirugía no es una opción viable, y se requiere una vía de tratamiento alternativa.
El manejo de primera línea implica la extirpación quirúrgica de la lesión —escisión local amplia, cirugía micrográfica de Mohs o escisión por etapas— con el objetivo de lograr márgenes histológicos limpios (negativos). Cuando ese objetivo no se alcanza, o cuando la cirugía no es factible o no es aceptada por el paciente, está indicada la escalada a este protocolo.
DOI: 10.3390/jcm13092527
According to experts, when surgery is not feasible or not accepted by the patient, imiquimod 5% cream as a monotherapy represents the treatment of choice, while radiotherapy represents a possible alternative treatment, but other topical treatments have also been used with inconsistent results, including cryotherapy, laser therapy, photodynamic therapy, 5-fluorouracil and tazarotene.
In patients who are not eligible for surgery or radiotherapy, imiquimod 5% can be used as a primary treatment option according to the published literature and in the experts' opinion.
Although there is no standardized regimen, the application of imiquimod with 1–2 cm margins for 5–7 days per week, over 12 weeks, leads to the best outcomes.
If the inflammation is extremely severe, leading to unacceptable pain or ulcerations, imiquimod should be stopped for a few days and resumed at a lower dose 2–3 days per week.
The objective of the treatment is to achieve visible inflammation for at least 10–11 weeks, with the intensity of the inflammatory response being directly associated with the clearance rate.
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