Extension of Telemedicine to Treatment Management of Lentigo Maligna with Neoadjuvant Topical Imiquimod

Lentigo maligna is a superficial spreading subtype of melanoma that occurs on chronically sun exposed skin and does not exhibit invasion at the deep margin. Current standard of care is 3 months of neoadjuvant topical imiquimod treatment, followed by a 1-2 month recuperation period, and a definitive staged excision procedure. Topical imiquimod, when used effectively, can reduce tumor burden and required surgical margin, thus reducing cosmetic penalty. Treatment is monitored with monthly in-office follow ups and must be titrated to achieve optimal level of inflammation. Excess inflammation can cause pain, bleeding, oozing, flu-like symptoms, and risk for infection. Inadequate inflammation can compromise efficacy of treatment and lead to a more aggressive definitive surgery.