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Lentigo maligna (LM) is an in situ variant of cutaneous melanoma, which usually occurs in sun-damaged skin. Surgical treatment of LM is often difficult and not well accepted by patients, as lesions are usually quite large and located on the face. Imiquimod 5% cream is a local immune response modifier that has been used off-label to treat LM. The authors report of 2 female patients with LM on the nose (aged 39 and 48 years) treated with imiquimod 5% cream applied 5 times a week for a total duration of 4 months. Videodermatoscopy, a noninvasive diagnostic technique, was used to address the diagnosis and to monitor treatment response with imiquimod therapy and during follow-up. At the end of the treatment period, the lesions had cleared in both patients, with no evident remnants confirmed by videodermatoscopy. The patients refused to undergo a control biopsy, but complied for a 30-month followed-up period which revealed no evident changes. The authors' experience, in agreement with other clinical reports and open trials, suggests that topical imiquimod is a valuable treatment option capable of leading LM to clinical clearance.

We report a case of a 43-year-old uncircumcised Caucasian, diabetic man with a 4-year history of Zoon's balanitis unresponsive to topical steroids, in whom control of the disease was achieved with topical imiquimod. A histopathological examination of a biopsy specimen was performed before and after treatment with imiquimod 5% cream applied 3 times a week. A moderate to marked increased local skin reaction occurred several times throughout the treatment period, necessitating multiple rest periods of several days' duration. Clinical but not histological resolution was obtained after 4 months of treatment, with no relapses at an 18-month follow-up. This positive treatment outcome indicates that imiquimod may have a role in the management of Zoon's balanitis. However, the dose and duration of therapy required to achieve complete clinical response still needs to be established. Also, the question of whether normalization of histology can be achieved with topical imiquimod has yet to be answered.

A 61-year-old woman developed multiple and clustered eruptive epidermoid cysts at the site of treatment of a basal cell carcinoma located on her nose with imiquimod 5% cream (5 times/week for 6 weeks). Clearing was achieved after topical treatment with tretinoin 0.025% cream (1 application/day for 1 month)., (2007 S. Karger AG, Basel)

Imiquimod is an immune response-modifying agent with potent antiviral and antitumor activity effective in the treatment of various skin disorders, including in situ carcinoma of the skin (Bowen's disease). The case of a 64-year-old man affected by an in situ carcinoma of the glans mucosa, namely erythroplasia of Queyrat, successfully treated with imiquimod 5% cream is described. Because the results of tests for human papillomavirus infection were negative in this case, we suggest that imiquimod may have acted through an antitumor effect mediated by cytokine activation. This compound may represent an alternative treatment in patients with erythroplasia of Queyrat, although the dosing schedule and treatment duration require further evaluation.

The efficacy and safety of imiquimod, an immune-response modifier approved for the treatment of anogenital warts that has antiviral and antitumor activity, in the management of an extensive superficial basal cell carcinoma (sBCC) of the face as an alternative to surgical treatment was evaluated in a 75-year-old male with a 4-year history of a progressively enlarging lesion located on the right temporal region. Imiquimod 5% cream was applied daily until clinical resolution. Histopathological confirmation of clinical diagnosis and of tumor clearance were performed before starting treatment and at the end of treatment, respectively. Moreover, monthly post-treatment follow-up visits were planned. At physical examination, an ovalar, erythematous and slightly infiltrated plaque of 5 x 4 cm in size (approximately 20 cm2), partly eroded and crusted, with a sharp, raised, pearly edge, was evident on the right temporal region of the patient. Histopathological examination of a biopsy specimen showed the typical features of sBCC. Imiquimod 5% cream applied daily for 5 months produced complete clinical and histological clearance. No adverse events but considerable irritation were reported during treatment and no relapses were clinically observed at the 6-month follow-up visit. Our findings confirm current reports from the literature showing imiquimod 5% cream to be an effective treatment for sBCC that is especially valuable in avoiding disfigurement in cases of single large lesions located on the face or in those patients who may not be surgical candidates.

Background: Periungual and subungual warts are very difficult to eradicate with current therapies. Most are destructive in nature (liquid nitrogen, cantharidin, vascular lesion laser) and inflammation, pain and pigment dyschromia are common side effects. Furthermore, failure to respond or appearance of new lesions often leads to even more destructive treatments (CO(2) laser, excisional surgery) and can lead to more pain and scarring., Methods: In an open trial, the efficacy, safety, and tolerability of topical imiquimod 5% cream was assessed in 15 patients with resistant and recurrent periungual and subungual warts over a 16 week period., Results: Twelve patients (80%) completed therapy, showing complete resolution after a mean time of three weeks (range 1-6 weeks), with the remaining three patients (20%) being classified as non-responders. Local side effects (erythema, pruritus, burning and pain) were generally mild and well-tolerated. No relapses occurred during a 6-month follow-up., Conclusion: Topical imiquimod is an interesting novel treatment for multiple periungual and subungual warts. Tolerability is excellent when compared to other commonly used modalities and there are few side effects. This trial suggests a high clinical response rate. This treatment is applicable to patients who have failed conventional therapies before embarking on potentially scarring approaches such as excisional surgery.

Intraepithelial penile carcinoma (IPC) is an in situ carcinoma of the penis, which can be difficult to diagnose. Current treatments include excisional surgery, Mohs' micrographic surgery, cryotherapy, carbon dioxide laser therapy and topical 5-fluorouracil. We report two cases of men with 12-18 month histories of IPC (Bowen's disease, squamous cell carcinoma in situ) that were previously unsuccessfully treated with antifungals and antibiotics. Treatment with imiquimod 5% cream for 8-10 weeks was effective in both cases with no clinical evidence of relapse at 4 and 6 months. Both patients experienced adverse effects, resulting in temporary discontinuation of treatment.

Gorlin's syndrome (naevoid basal cell carcinoma) is an autosomal dominant tumour-predisposition syndrome. It typically consists of multiple basal cell carcinomas (BCCs) of the skin, odontogenic keratocysts of the jaw, various skeletal abnormalities and lamellar falx calcifications. Four patients with multiple facial and trunk BCCs (superficial and nodular) consistent with Gorlin's syndrome are reported. Imiquimod 5% cream was topically applied to the lesions 3-5 times a week for 8-14 weeks. Two of the patients suffered mild to severe erythema and developed superficial erosions but did not discontinue treatment. Imiquimod 5% cream successfully treated 13 out of 17 BCCs in these patients with Gorlin's syndrome, with no patient suffering a relapse at the follow-up visit.