Electrochemotherapy, as a novel therapeutic approach in the management of lentigo maligna, lentigo maligna melanoma, and acral lentiginous melanoma

Abstract

Purpose: Lentigo maligna (LM), lentigo maligna melanoma (LMM), and acral lentiginous melanoma (ALM) are characterized by irregular borders and manifest on highly visible and/or surgically challenging areas. The challenge in treating these melanomas lies in preserving function and achieving satisfactory esthetic outcomes while ensuring complete surgical excision with an appropriate safety margin. We report three cases of elderly patients with LM, LMM, and ALM treated with electrochemotherapy (ECT).

Materials and methods: All patients were treated according to the European Standard Operating Procedures of Electrochemotherapy protocol. Bleomycin was administered intravenously, followed by electroporation to allow better drug uptake into the tumor cells. The safety margin was ensured by electrode repositioning, and follow-up was scheduled regularly.

Results: Our patients experienced favorable outcomes: two achieved a complete response, with one requiring adjuvant topical imiquimod for suspected residual disease, while the third patient achieved a partial response. No serious adverse events were observed, and cosmetic results were superior compared to extensive surgery.

Conclusion: ECT appears to be a safe and effective treatment alternative for LM, LMM, and ALM, especially in elderly patients where surgery may lead to significant morbidity. ECT can be used alone or in combination with other therapies, providing a wide safety margin and cosmetically favorable results.

Keywords: Bleomycin; electrochemotherapy; imiquimod; irradiation; melanoma.