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Aktuelle Dermatologie 2016; 42(12): 507-509
DOI: 10.1055/s-0042-120109
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Topische Therapiemöglichkeiten bei der Lentigo maligna

Topical Treatment of Lentigo Maligna
C. Bürgler
Universitätsklinik für Dermatologie, Inselspital, Universität Bern, Schweiz
,
K. Gadaldi
Universitätsklinik für Dermatologie, Inselspital, Universität Bern, Schweiz
,
R. E. Hunger
Universitätsklinik für Dermatologie, Inselspital, Universität Bern, Schweiz
› Author Affiliations
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Publication History

Publication Date:
06 December 2016 (online)

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Zusammenfassung

Lentigo maligna (LM) ist ein Melanoma in situ in chronisch sonnengeschädigter Haut und betrifft hauptsächlich die Kopf- und Halsregion älterer Patienten. Diverse Therapiemodalitäten (Chirurgie, Kryotherapie, Radiotherapie, Imiquimod) werden mit Erfolg angewandt, wobei die chirurgische Exzision die Therapie der Wahl ist. Je nach Größe, Lokalisation oder Komorbiditäten kann die Chirurgie jedoch kontraindiziert sein. Die topische Therapie mit Imiquimod 5 % ist in diesen Fällen eine gute Alternative. Durch seine immunmodulatorische Wirkung führt Imiquimod zu einer lokalen Tumor-Antwort, welche in 53 – 100 % zu einer kompletten Abheilung führt. Rezidive werden in 15 – 20 % beobachtet. Die Anwendung von Imiquimod zur Therapie der LM ist off-label. Es existieren Fallberichte und kleine Fallserien für weitere topische Substanzen wie Ingenolmebutat, 5-Fluorouracil und topische Retinoide. Zurzeit fehlen jedoch genügend Daten, um deren Anwendung zu empfehlen. Eine regelmäßige Nachsorge von erfolgreich topisch behandelten Patienten mit Lentigo maligna ist unabdingbar, um Rezidive frühzeitig zu erkennen.

Abstract

Lentigo maligna (LM) is a melanoma in situ on chronically sun-damaged skin, with a strong predilection to the head and neck area of the elderly. Several therapeutic options (surgery, cryotherapy, radiotherapy, imiquimod) have demonstrated efficacy in the treatment of LM. Surgical excision is the first-line therapy but can be contraindicated for comorbid patients, larger lesions and according to their location. In such cases, a topical therapy with Imiquimod 5 % is a valuable alternative treatment. Its immune modifying action leads to a local anti-tumor response, which leads to a complete response in 53 – 100 % of patients. Recurrence of LM can be observed in 15 – 20 % of patients. The treatment of LM with Imiquimod is off-label. A few case reports and small case series exist for other topic treatment modalities such as ingenol mebutate, 5-fluorouracil and topical retinoids. To date, sufficient data which would support their use are lacking. A close follow-up of patients suffering from LM which were sucessfully treated with topical treatment modalities is essential to detect recurrence early.

 

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