In-transit metastasis in melanoma: Efficacy of topical imiquimod combined with carbon dioxide laser or with electrocautery

• Published in: Annales de dermatologie et de vénéréologie Vol. 141; no. 2; pp. 106 - 110
• Main Authors: Elfatoiki, F-Z, Longvert, C, Clerici, T, Bourgault-Villada, I, Roudier-Pujol, C, Vasseur, E, Saiag, P
• Format: Journal Article
• Language: French
• Published: France 01-02-2014
• Subjects: Administration, Cutaneous; Adult; Aged; Aminoquinolines - administration & dosage; Aminoquinolines - therapeutic use; Antineoplastic Agents - administration & dosage; Antineoplastic Agents - therapeutic use; Combined Modality Therapy; Disease Progression; Electrocoagulation; Facial Neoplasms - drug therapy; Facial Neoplasms - pathology; Facial Neoplasms - secondary; Facial Neoplasms - surgery; Fatal Outcome; Humans; Interferon-alpha - therapeutic use; Laser Therapy; Lasers, Gas; Leg; Lymphatic Metastasis; Male; Melanoma - drug therapy; Melanoma - secondary; Melanoma - surgery; Palliative Care; Remission Induction; Sentinel Lymph Node Biopsy; Skin Neoplasms - drug therapy; Skin Neoplasms - secondary; Skin Neoplasms - surgery; Topical imiquimod; Métastases cutanées en transit; Electrocoagulation; Carbon dioxide laser; Mélanome; Laser CO; Melanoma; Électrocoagulation; In-transit metastases in cutaneous melanoma; Imiquimod topique
• ISSN: 0151-9638
• DOI: 10.1016/j.annder.2013.10.058

In-transit metastases in cutaneous melanoma are common and difficult to manage. Therapy is mainly palliative. Use of topical imiquimod has been assessed for surface metastases.
We report on four patients with cutaneous melanoma metastases treated with topical imiquimod associated with carbon dioxide laser in the first two patients and with electrocoagulation in the two others. For two patients, we noted complete regression of the lesions after 15 and 18 months. For the two others, treatment was stopped after 9 to 10 months because of progression of subcutaneous metastasis and distant metastasis.
Topical imiquimod is an alternative treatment used in superficial in-transit metastasis of melanoma. Its use as a monotherapy is sometimes ineffective. We elected to use combined pre-treatment with carbon dioxide laser or electrocoagulation in order to potentiate the action of imiquimod. This simple and inexpensive therapeutic strategy constitutes a palliative treatment that can allow prolonged local control of cutaneous metastasis.