RT Book, Section A1 Karnes, Jonathan B. A1 Mayeaux, Jr., E.J. A1 Usatine, Richard P. A2 Usatine, Richard P. A2 Smith, Mindy A. A2 Mayeaux, Jr., E.J. A2 Chumley, Heidi S. SR Print(0) ID 1164361374 T1 Lentigo Maligna T2 The Color Atlas and Synopsis of Family Medicine, 3e YR 2019 FD 2019 PB McGraw-Hill Education PP New York, NY SN 9781259862045 LK dermatology.mhmedical.com/content.aspx?aid=1164361374 RD 2024/03/28 AB A 67-year-old man noted that a brown spot on his face was growing larger and darker (Figure 175-1). Dermoscopy was performed, and polygonal lines and rhomboidal structures were seen around the follicular openings (Figure 175-2). A broad shave biopsy of the whole lesion showed lentigo maligna (LM) (melanoma in situ). The patient had a long history of multiple skin cancers including multiple thin melanomas on his back. He also had cardiac problems and was on Coumadin. The options for treatment were presented, and he chose to try topical imiquimod. He was instructed to apply the imiquimod daily to the involved area and was seen monthly. After 2 months it was obvious that he was having an exuberant inflammatory response to the imiquimod as desired (Figure 175-3). He completed the 3-month course. Three months after completion his face appeared completely clear (Figure 175-4) clinically and dermoscopically.