The standard of care for primary cutaneous melanoma is the surgical removal of the tumor; however, this may not be possible for patients with specific comorbidities, depending on the size and location of the lesion, or due to concerns about the impact on their ability to perform daily tasks. Infrequently used alone or in conjunction with other therapies, imiquimod is topical immunotherapy for melanoma.

O’Hern et al presented a literature review on the safety and efficacy of imiquimod in the treatment of cutaneous primary and metastatic melanoma. The literature review revealed that although imiquimod in cutaneous primary and metastatic melanoma remains scarce, most evidence derived from case reports and series is likely to be influenced by selection bias for positive treatment results. However, imiquimod remains a relatively well-tolerated treatment for cutaneous primary and metastatic melanoma. It may be used in cases where surgery and/or systemic therapies are contraindicated or refused. It is particularly important for elderly patients with comorbidities that provide an excessive surgical risk or for whom the burden of cutaneous tumor metastases is too severe to be treated with surgery alone.

Source: O’Hern, K, Chambers M, Liang ST, et al. Topical 5% imiquimod as monotherapy for primary cutaneous and cutaneous metastatic melanoma: systematic review of the literature. Open Dermatol J. 2021;15:1-10.