Topical imiquimod in the treatment of metastatic melanoma to skin.

An 86-year-old woman presented in 1999 with a malignant melanoma (Clark level IV; Breslow thickness, 1.9 mm) on her right knee, which was initially treated with wide excision. In August 2000, several skin lesions of metastatic melanoma were noted on the right lower leg. These were treated with carbon-dioxide laser ablation. Multiple new skin-colored, brownish red, and dark blue smooth-surfaced and eroded papules and nodules of metastatic melanoma appeared on the whole right lower leg in December 2000 (Figure 1A). A large ulcerated nodule (2 cm in diameter) was noted on the right lateral crural region (Figure 2A). Two lesions were excised and metastatic melanoma was confirmed histopathologically. No lymph node or visceral metastases were found after staging procedures (x-ray of the thorax and sonography of the abdomen and the regional lymph nodes) were performed.