{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:29:20Z","timestamp":1785403760363,"version":"3.56.0"},"reference-count":8,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010805","name":"FORSS","doi-asserted-by":"publisher","award":["982375, 1003664"],"award-info":[{"award-number":["982375, 1003664"]}],"id":[{"id":"10.13039\/100010805","id-type":"DOI","asserted-by":"publisher"}]},{"award":["982375, 1003664"],"award-info":[{"award-number":["982375, 1003664"]}],"id":[{"id":"https:\/\/ror.org\/00brmfv24","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: Lentigo maligna (LM) represents melanoma in situ and predominantly affects elderly individuals, typically arising on chronically sun-exposed skin of the head and neck. Although LM is characterized by slow horizontal growth and generally favourable prognosis, progression to invasive lentigo maligna melanoma may occur, making timely and effective treatment essential. Surgical excision remains the standard of care; however, advanced age, comorbidities, lesion size, and cosmetic or functional considerations may limit surgical feasibility. Case presentation: We report the case of a 93-year-old woman with no prior history of skin cancer who presented with a gradually enlarging pigmented lesion on the forehead. Clinical examination revealed an irregularly pigmented macule measuring 25 \u00d7 27 mm. Multiple mapping biopsies confirmed melanoma in situ of the lentigo maligna type, with adnexal extension and no evidence of dermal invasion. Given the patient\u2019s advanced age and lesion location, a non-surgical approach was selected. Topical imiquimod 5% cream was applied five times per week for 12 weeks to the visible lesion and to a 20 mm margin around it. The patient was monitored closely throughout the treatment. Local inflammatory reactions were mild to moderate, consisting mainly of erythema, crusting, and superficial erosion, without systemic adverse effects. At treatment completion, marked clinical improvement with near-complete resolution of pigmentation was observed. Follow-up dermoscopic evaluation demonstrated only minimal residual granular pigmentation. Post-treatment mapping biopsies confirmed complete histological clearance of atypical melanocytic cells. Conclusions: This case illustrates that topical imiquimod may serve as a safe and effective alternative to surgery in carefully selected elderly patients with lentigo maligna. Close clinical follow-up and histological confirmation of clearance are essential to ensure treatment success and durable outcomes.<\/jats:p>","DOI":"10.3390\/life16050863","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T06:42:18Z","timestamp":1779691338000},"page":"863","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Topical Imiquimod for Lentigo Maligna in a Nonagenarian"],"prefix":"10.3390","volume":"16","author":[{"given":"Sarah","family":"Hosseini","sequence":"first","affiliation":[{"name":"Department of Dermatology and Venereology, Ryhov County Hospital, Sjukhusgatan, 553 05 J\u00f6nk\u00f6ping, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1924-0149","authenticated-orcid":false,"given":"Georgios","family":"Kravvas","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Whittington Health NHS Trust, Magdala Avenue, London N19 5NF, UK"},{"name":"Department of Dermatology, University College London Hospitals (UCLH), 235 Euston Road, London NW1 2BU, UK"},{"name":"Division of Medicine, University College London, 5 University St., London WC1E 6JF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1051-043X","authenticated-orcid":false,"given":"Sandra","family":"Jerkovic Gulin","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Venereology, Ryhov County Hospital, Sjukhusgatan, 553 05 J\u00f6nk\u00f6ping, Sweden"},{"name":"Division of Cell Biology, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Link\u00f6ping University, 581 83 Link\u00f6ping, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"884","DOI":"10.2340\/00015555-3241","article-title":"Effectiveness of 5% topical imiquimod for lentigo maligna treatment","volume":"99","author":"Tio","year":"2019","journal-title":"Acta Derm.-Venereol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"T413","DOI":"10.1016\/j.ad.2023.04.023","article-title":"Update on lentigo maligna: Diagnostic signs and treatment = El lentigo maligno: Actualizaci\u00f3n y claves en el diagn\u00f3stico y el tratamiento","volume":"114","author":"Requena","year":"2023","journal-title":"Actas Dermo-Sifiliogr\u00e1ficas"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"837","DOI":"10.2147\/CCID.S224738","article-title":"Lentigo maligna: Clinical presentation and appropriate management","volume":"13","author":"Iznardo","year":"2020","journal-title":"Clin. Cosmet. Investig. Dermatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"171","DOI":"10.2217\/mmt.15.3","article-title":"Lentigo maligna and lentigo maligna melanoma: Contemporary issues in diagnosis and management","volume":"2","author":"Connolly","year":"2015","journal-title":"Melanoma Manag."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1016\/j.jaad.2018.08.055","article-title":"Guidelines of care for the management of primary cutaneous melanoma","volume":"80","author":"Swetter","year":"2019","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1785","DOI":"10.1111\/jdv.19141","article-title":"Efficacy of imiquimod in the management of lentigo maligna","volume":"37","author":"Daude","year":"2023","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1001\/jamadermatol.2019.0467","article-title":"Histologic features associated with an invasive component in lentigo maligna lesions","volume":"155","author":"Moreno","year":"2019","journal-title":"JAMA Dermatol."},{"key":"ref_8","unstructured":"Puckett, Y., Geist, R., and Chen, C.S.J. (2025, September 21). Lentigo Maligna Melanoma, StatPearls [Internet], Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK482163\/."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/5\/863\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T15:16:44Z","timestamp":1779722204000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/5\/863"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,21]]},"references-count":8,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["life16050863"],"URL":"https:\/\/doi.org\/10.3390\/life16050863","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,21]]}}}