Patients suffering from chronic lymphocytic leukemia often develop actinic keratosis (AK) and squamous cell carcinoma in sun-exposed areas. In these particular patients, who have a suboptimal immune function, AK treatment can be particularly challenging. We report the case of a patient who failed to respond to most AK treatments, including 5-FU, imiquimod and photodynamic therapy, but responded to ingenol mebutate. We started with 3 applications of 150 μg/g (registered treatment of the scalp) and also 2 applications of 500 μg/g (registered in for trunk and extremities). Both treatments were well tolerated, but only the latter led to significant clinical success. This suggests that 500 μg/g of ingenol mebutate may represent an interesting therapeutic option in patients with mild immunosuppression.

Keywords:
Ingenol mebutate, Field cancerization, Immunosuppression, Actinic keratosis, LLC, Scalp
1.
Perez-Reyes N, Farhi DC: Squamous cell carcinoma of head and neck in patients with well-differentiated lymphocytic lymphoma. Cancer 1987;59:540-544.
2.
Levi F, Randimbison L, Te VC, La Vecchia C: Non-hodgkin's lymphomas, chronic lymphocytic leukaemias and skin cancers. Br J Cancer 1996;74:1847-1850.
3.
Ulrich C, Bichel J, Euvrard S, Guidi B, Proby CM, van de Kerkhof PC, Amerio P, Rønnevig J, Slade HB, Stockfleth E: Topical immunomodulation under systemic immunosuppression: results of a multicentre, randomized, placebo-controlled safety and efficacy study of imiquimod 5% cream for the treatment of actinic keratoses in kidney, heart, and liver transplant patients. Br J Dermatol 2007;157(suppl 2):25-31.
4.
Alessi SS, Sanches JA, Oliveira WR, Messina MC, Pimentel ER, Festa Neto C: Treatment of cutaneous tumors with topical 5% imiquimod cream. Clinics (Sao Paulo) 2009;64:961-966.
© 2016 S. Karger AG, Basel
2016
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