Long-Term Follow-Up of Lentigo Maligna Patients Treated with Imiquimod 5% Cream

SIMPLE SUMMARY: The study aimed to investigate the long-term efficacy of imiquimod 5% cream for lentigo maligna, with a focus on disease recurrence and the possible prognostic factors of disease-free survival. If surgical excision is not possible due to the patients’ age/comorbidities or critical cosmetic localization, imiquimod provides promising outcomes with an optimal risk of relapse for the management of LM. ABSTRACT: Background: The study investigated the long-term efficacy of imiquimod 5% cream for LM, with a focus on disease recurrence and the possible prognostic factors of disease-free survival (DFS) in a cohort, with long-term follow-up. Methods: Consecutive patients with histologically confirmed LM were included. Imiquimod 5% cream was applied until weeping erosion appeared on the LM-affected skin. The evaluation was performed through clinical examination and dermoscopy. Results: We analyzed 111 patients with LM (median age: 72 years, 61.3% women) with tumor clearance after imiquimod therapy, with a median follow-up of 8 years. The overall patient survival rates were 85.5% (95% confidence interval (CI): 78.5–92.6) and 70.4% (95% CI: 60.3–80.5) at 5 and 10 years, respectively. Among the 23 patients (20.1%) with relapse at follow-up, 17 (73.9%) were treated with surgery, five (21.7%) continued imiquimod therapy, and one (4.3%) underwent both surgery and radiotherapy. After adjustment for age and LM area in multivariable models, localization of LM in the nasal region was identified as a prognostic factor for DFS (HR = 2.66; 95% CI: 1.06–6.64). Conclusion: If surgical excision is not possible due to the patients’ age/comorbidities or critical cosmetic localization, imiquimod could provide optimal outcomes with an optimal risk of relapse for the management of LM.