Immunocryosurgery as Primary Treatment for Lentigo Maligna and as an Adjuvant Therapy for Lentigo Maligna Melanoma: A 21-Patient Case Series.

Introduction: Lentigo maligna (LM) and lentigo maligna melanoma (LMM) often occur in cosmetically sensitive areas and may affect patients who are unsuitable for extensive surgery. This study evaluated immunocryosurgery as a primary treatment for LM and as adjuvant therapy after excision of the invasive component in LMM.

Methods: This retrospective case series included 21 patients treated between 2015 and 2024, comprising 16 patients with histologically confirmed LM and 5 with histologically confirmed LMM. LM lesions were treated with immunocryosurgery alone, whereas LMM cases underwent limited excision of the invasive focus followed by adjuvant immunocryosurgery. The protocol consisted of a 3-week induction phase with daily topical imiquimod 5%, a single cryosurgery session without interrupting imiquimod, and 6 months of maintenance imiquimod. Patients were followed clinically and dermoscopically for recurrence, adverse events, and cosmetic outcomes.

Results: After a median follow-up of 31 months, no recurrence occurred among patients with LM. Among patients with LMM, one developed local recurrence at 21 and 96 months, both of which were successfully retreated with the same regimen. Another patient developed a suspected local recurrence at 23 months that was treated empirically, with no further recurrence after 100 months of follow-up. All patients completed treatment, although temporary treatment interruptions occurred in 42.9%. Cosmetic outcomes were rated as excellent or good in 90.5% of cases. No melanoma-related deaths occurred.

Conclusion: Immunocryosurgery provided durable local control and favorable cosmetic outcomes in this case series. It may represent a treatment option for selected patients with LM or LMM who are unsuitable for conventional surgery.