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

Immunocryosurgery was evaluated as primary treatment for lentigo maligna (LM) and as adjuvant therapy after excision of the invasive component in lentigo maligna melanoma (LMM) in a retrospective case series of 21 patients treated between 2015 and 2024, including 16 with histologically confirmed LM and 5 with LMM. LM lesions were managed 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%, one cryosurgery session without interrupting imiquimod, and 6 months of maintenance imiquimod. Patients were followed clinically and dermoscopically for recurrence, adverse effects, and cosmetic outcomes. After a median follow-up of 31 months, no LM patient developed recurrence. Among LMM patients, one developed local recurrences at 21 and 96 months, both successfully retreated with the same protocol. Another developed a suspected local recurrence at 23 months, treated empirically, with no further recurrence after 100 months. All patients completed treatment. Temporary interruptions occurred in 42.9%. Cosmetic outcomes were excellent or good in 90.5% of cases. No melanoma-related deaths occurred. These findings suggest that immunocryosurgery may provide durable local control and favourable cosmetic outcomes in selected LM/LMM patients unsuitable for surgery.