Lentigo Maligna and Radiotherapy
http://www.100md.com
《新英格兰医药杂志》
To the Editor: Imiquimod has recently been shown to be effective in the management of lentigo maligna, as demonstrated in Images in Clinical Medicine (Nov. 17 issue)1 and in other reports. The authors correctly suggest that imiquimod may be effective for lentigo maligna, but readers are subsequently led to believe that perhaps this is the only alternative to surgery. Although imiquimod may be a promising nonsurgical alternative for the treatment of lentigo maligna, radiotherapy has been clinically successful, with excellent cosmesis. In one series of 101 patients with either lentigo maligna or lentigo maligna melanoma who were treated with radiotherapy and followed for a minimum of 2 years (mean, 8 years), the mean time to recurrence was 45.6 months, with a recurrence rate of 7 percent.2 Although radiotherapy may not be as convenient as treatment with a self-administered topical agent, it should be recognized as a potential therapeutic choice for patients with lentigo maligna. Radiotherapy can provide excellent cosmesis and local control.
Lynn D. Wilson, M.D., M.P.H.
Yale University School of Medicine
New Haven, CT 06510
lynn.wilson@yale.edu
References
Noel B, Kunzle N. Lentigo maligna. N Engl J Med 2005;353:2176-2176.
Farshad A, Burg G, Panizzon R, Drummer R. A retrospective study of 150 patients with lentigo maligna and lentigo maligna melanoma and the effect of radiotherapy using Grenz or soft X-rays. Br J Dermatol 2002;146:1042-1046.
The author replies: I agree with Dr. Wilson that radiotherapy is the most effective nonsurgical treatment for lentigo maligna.1 However, imiquimod is an emerging new treatment that has many advantages. It can be administered by the patient, reducing the cost of treatment. Side effects, such as skin irritation, are transient and resolve spontaneously after treatment, leaving no scars or skin marks. By contrast, radiotherapy may induce chronic radiodermatitis and, sometimes, skin cancer.2 Imiquimod not only stimulates the immune system but also inhibits angiogenesis, a fact that contributes to its clinical efficacy against different types of dermatologic conditions such as genital warts, actinic keratoses, lentigo maligna, basal-cell carcinoma, and squamous-cell carcinoma.3
Bernard No?l, M.D.
Centre Hospitalier Universitaire Vaudois
1011 Lausanne, Switzerland
bernard.noel@chuv.ch
References
Zalaudek I, Horn M, Richtig E, Hodl S, Kerl H, Smolle J. Local recurrence in melanoma in situ: influence of sex, age, site of involvement and therapeutic modalities. Br J Dermatol 2003;148:703-708.
Suter L. Long-term (chronic, late) radiation reactions of the skin. In: Panizzon RG, Cooper JS, eds. Radiation treatment and radiation reactions in dermatology. Berlin: Springer-Verlag, 2004:143-57.
Hengge UR, Schaller J. Successful treatment of invasive squamous cell carcinoma using topical imiquimod. Arch Dermatol 2004;140:404-406.
Lynn D. Wilson, M.D., M.P.H.
Yale University School of Medicine
New Haven, CT 06510
lynn.wilson@yale.edu
References
Noel B, Kunzle N. Lentigo maligna. N Engl J Med 2005;353:2176-2176.
Farshad A, Burg G, Panizzon R, Drummer R. A retrospective study of 150 patients with lentigo maligna and lentigo maligna melanoma and the effect of radiotherapy using Grenz or soft X-rays. Br J Dermatol 2002;146:1042-1046.
The author replies: I agree with Dr. Wilson that radiotherapy is the most effective nonsurgical treatment for lentigo maligna.1 However, imiquimod is an emerging new treatment that has many advantages. It can be administered by the patient, reducing the cost of treatment. Side effects, such as skin irritation, are transient and resolve spontaneously after treatment, leaving no scars or skin marks. By contrast, radiotherapy may induce chronic radiodermatitis and, sometimes, skin cancer.2 Imiquimod not only stimulates the immune system but also inhibits angiogenesis, a fact that contributes to its clinical efficacy against different types of dermatologic conditions such as genital warts, actinic keratoses, lentigo maligna, basal-cell carcinoma, and squamous-cell carcinoma.3
Bernard No?l, M.D.
Centre Hospitalier Universitaire Vaudois
1011 Lausanne, Switzerland
bernard.noel@chuv.ch
References
Zalaudek I, Horn M, Richtig E, Hodl S, Kerl H, Smolle J. Local recurrence in melanoma in situ: influence of sex, age, site of involvement and therapeutic modalities. Br J Dermatol 2003;148:703-708.
Suter L. Long-term (chronic, late) radiation reactions of the skin. In: Panizzon RG, Cooper JS, eds. Radiation treatment and radiation reactions in dermatology. Berlin: Springer-Verlag, 2004:143-57.
Hengge UR, Schaller J. Successful treatment of invasive squamous cell carcinoma using topical imiquimod. Arch Dermatol 2004;140:404-406.