ABSTRACT
BACKGROUND: Either cryosurgery or topical imiquimod have been used to treat patients with lentigo maligna in cases where surgery is not feasible. METHODS: We report a patient with lentigo maligna, who was treated with the combination of topical imiquimod and cryosurgery, and review the rationale, which led us to design the present combined cryo-immunological treatment modality. RESULTS: Sustained clearance of lentigo maligna to date (26 months after treatment). The successful treatment of this patient was based on the following rationale: A cryosurgery session during continuing imiquimod application may: (i) reinforce apoptosis of tumor cells; (ii) strengthen antiangiogenesis in the treated tumor; and (iii) build-up a potent tumor-destructive immune response by a cascade of events starting with imiquimod-promoted attraction of immature dendritic antigen-presenting cells (DCs) into the tumor. DCs further mature within the tumor-antigen-rich environment of subsequently cryo-destructed tumor and upon imiquimod-driven migration into the peripheral lymph nodes can stimulate a specific antineoplastic cell-mediated immunity. Finally, continuing imiquimod application after cryosurgery may increase recruitment of activated effector cells into the tumor tissue leading to its destruction. CONCLUSION: Cryosurgery during continued topical imiquimod seems to be a promising treatment for lentigo maligna.
