Ann Dermatol.  2018 Aug;30(4):454-457. 10.5021/ad.2018.30.4.454.

Development of Vitiligo-Like Depigmentation after Treatment of Lentigo Maligna Melanoma with 5% Imiquimod Cream

• Kim NH
• Lee JB
• Yun SJ

• KMID: 2457523
• DOI: http://doi.org/10.5021/ad.2018.30.4.454

Abstract

A 69-year-old man presented with a black irregular patch on his left cheek. Skin biopsy revealed lentigo maligna melanoma in situ. He was treated via partial excision of the melanoma, followed by the application of 5% imiquimod cream every other night for 6 to 8 hours. The patient experienced severe local inflammation accompanied by burning, edema, and erythema, as well as oozing and crusting. The patient discontinued using the imiquimod cream after 15 applications because of the inflammation. Depigmentation was noted in the treated area 3 months after the initiation of treatment with imiquimod cream. Histological examination using Melan-A staining of the depigmented area revealed an absence of melanocytes, which is consistent with vitiligo. The depigmented lesions improved considerably after a 5-year follow-up, and there was no recurrence of melanoma.

Keyword

Lentigo maligna; Melanoma; Toll-like receptor; Vitiligo

MeSH Terms

Aged
Biopsy
Burns
Cheek
Edema
Erythema
Follow-Up Studies
Humans
Hutchinson's Melanotic Freckle*
Inflammation
Lentigo*
MART-1 Antigen
Melanocytes
Melanoma*
Recurrence
Skin
Toll-Like Receptors
Vitiligo
MART-1 Antigen
Toll-Like Receptors

Figure

• 

  Fig. 1 Clinical photographs prior to and after partial excision of melanoma in situ. (A) A large black patch with an unclear boundary and uneven color on the left cheek prior to treatment. (B) Remaining black patch after partial excision of melanoma.

• 

  Fig. 2 (A) Severe local inflammatory reaction occurred after application of 5% imiquimod cream. (B) Depigmented lesions are observed in the treated area after 3 months. (C) Histological examination using Melan-A staining of the depigmented area revealed the absence of melanocytes (×100). (D) Partial improvement in vitiligo-like depigmentation after 5-year treatment without recurrence of melanoma.

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