The incidence of in situ melanoma (MIS) has increased over the last decades. The mainstay of treatment for MIS, including lentigo maligna (LM), is complete surgical excision with clear margins (0.5 to 1.0 cm). Nevertheless, MIS lesions often affect elderly patients with comorbidities and involve large lesions in cosmetically sensitive areas, which means surgery is not always appropriate. Non-surgical treatments have a role in these cases, and include radiotherapy, cryosurgery, immunotherapy, laser therapy, and other topical medications. This study aims to review the applications of immunotherapy in MIS, either in monotherapy or in combination with other therapeutic alternatives. The main forms of immunotherapy used are imiquimod and, to a lesser extent, intralesional interferon-α (IL-INF-α) and ingenol mebutate (IM). IL-INF-α and IM have not been studied as extensively as imiquimod, whose results in real-life practice are encouraging. The clearance and recurrence rates reported in MIS treated with imiquimod as monotherapy, or as an adjuvant after surgery with affected or narrow margins, make imiquimod a reliable therapeutic alternative in selected cases. Also, its use as a neoadjuvant therapy before surgery was shown to reduce the final surgical defect size required to confirm negative histologic margins. In conclusion, local immunotherapy is frequently used in clinical practice and experience confirms it to be an excellent option for certain patients.
原位黑色素瘤的发病率在过去几十年中持续上升。目前该病（包括恶性雀斑样痣）的主要治疗手段是采用0.5-1.0厘米安全切缘的完整手术切除。然而，原位黑色素瘤常发生于伴有合并症的老年患者，且病灶多位于美容敏感区域并呈大面积分布，这使得手术治疗并非总是适宜选择。在此类情况下，非手术治疗具有重要价值，包括放射治疗、冷冻手术、免疫疗法、激光治疗及其他局部药物治疗。本研究旨在系统评述免疫疗法在原位黑色素瘤治疗中的应用，包括单药治疗及与其他治疗方案的联合应用。目前主要应用的免疫治疗形式包括咪喹莫特，以及使用较少的病灶内干扰素-α和ingenol mebutate。与咪喹莫特相比，后两种疗法的研究尚不充分，而咪喹莫特在实际临床应用中已展现出令人鼓舞的疗效。无论是作为单药治疗，还是作为切缘受累或狭窄术后辅助治疗，咪喹莫特在原位黑色素瘤治疗中报告的清除率和复发率数据表明，该疗法在特定病例中可作为可靠的治疗选择。此外，术前新辅助应用该疗法可有效缩小最终手术缺损范围，从而确保组织学切缘阴性。综上所述，局部免疫疗法在临床实践中已得到广泛应用，经验证实其为特定患者群体提供了优质治疗选择。
Topical and Intralesional Immunotherapy for Melanoma In Situ: A Review
肿瘤(癌症)患者之家