Imiquimod: Topical Cream To Fight Skin Cancer Along With Surgery

By Margarita Nahapetyan

Scientists at St. Louis University found that the topical cream imiquimod along with surgery may treat the earliest stage of melanoma-type skin cancer, called lentigo maligna (LM). Doctors say that this cream allows patients to undergo less invasive surgery preventing disfiguring scarring, especially with skin cancers of the head and neck, as well as it could stop the cancer from coming back.

This early form of skin cancer precedes the more invasive form, lentigo maligna melanoma (LMM), and the progression of lentigo maligna to lentigo maligna melanoma generally occurs between 10 to 15 years later. In spite of the fact that surgical removal of LM is most often used to treat the non-invasive form of the cancer, it can have high local recurrence rates.

In two individuals who had both LM and LMM, the experts used the topical cream imiquimod in combination with surgery. In both cases, they first performed surgery, in order to remove the area of known skin disease, and after that they administered the topical cream to the outer area of LM. This combined approach was chosen with patients who did not want large-scale disfiguring surgery due to the large size of the melanoma on their scalp and face. These cases, along with other previous studies, show that without the use of imiquimod, skin cancers on the patients' scalp and face would have required the removal of a large section of deep tissue, leaving the patients disfigured.

Dr. Fosko, M.D., chairman of the department of dermatology at Saint Louis University School of Medicine and a lead author of the study, said that as skin cancer is affecting younger and younger individuals in their 20s, 30s and 40s, in alarmingly increasing numbers, there is a longer period of time for the cancer to come back and a greater desire by patients to avoid disfiguring surgery.

Scientists hope that topical creams such as imiquimod may be used to decrease the seriousness and the cost associated with the disease, as well as limit after-surgery scars and, what is even more important, improve patient care. This sub-type of skin cancer is becoming more and more common, and can be one of the most challenging melanomas to manage, said Fosko, who is also director of the melanoma and cutaneous oncology section of the Saint Louis University Cancer Center. The investigator added that more research is needed on the matter in order to determine how the cream works and which patients are more likely to get the most benefit from it. Scientists are quite optimistic thinking that the drug may prove to be a good option for some patients. "This may be an effective first line treatment," Dr. Fosco said.

Doctors say that the best way to detect skin cancer at an early stage is to undergo screenings from time to time. Regular skin screenings are recommended for everyone, especially for individuals over 40 years of age, and people who are at increased risk for skin cancer. Also, screenings are recommended for those who have a fair complexion, who sunburn easily, have numerous moles, a personal or family history of skin cancer, and by occupation, recreation or use of tanning salons, get a great amount of sun or UV rays exposure, regardless of age or race.

The findings are published in the journal Dermatologic Surgery.