In situ photoimmunotherapy: a tumour-directed treatment for melanoma

Br J Dermatol. 2006 Dec;155(6):1287-92. doi: 10.1111/j.1365-2133.2006.07514.x.


We report a new immunological treatment for advanced cutaneous melanoma which combines laser stimulation with topical application of a toll-like receptor agonist. This treatment, in situ photoimmunotherapy (ISPI), provides an alternative to traditional therapies for melanoma patients with cutaneous metastases. A 6-week cycle of ISPI is carried out on cutaneous metastases located in a designated 20 x 20 cm treatment area: 2 weeks of pretreatment with twice-daily topical applications of imiquimod (5% cream under plastic occlusion), with a laser treatment session at week 2 and again at week 4. Topical imiquimod is continued for the entire 6-week cycle. Two patients with late-stage melanoma were treated with ISPI. Patient 1 had the primary tumour and local metastases on the left arm, as well as metastatic tumours in the lungs [American Joint Committee on Cancer (AJCC) stage IV]. Patient 2 had a head and neck melanoma with multiple local metastases (AJCC stage IIIC), which had failed repeated attempts at surgical resection and high-dose radiation therapy. Patient 1 is now free of all clinically detectable tumours (including the lung metastases) >20 months after the first treatment cycle. Patient 2 has been free of any clinical evidence of the tumour for over 6 months. These two cases demonstrate that ISPI can clear local tumour and trigger beneficial systemic responses, with a side-effect profile that compares favourably with other treatments for advanced melanoma.

Publication types

  • Case Reports
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aminoquinolines / therapeutic use*
  • Antineoplastic Agents / therapeutic use*
  • Combined Modality Therapy
  • Female
  • Humans
  • Imiquimod
  • Infrared Rays / therapeutic use
  • Laser Therapy
  • Lung Neoplasms / drug therapy
  • Lung Neoplasms / secondary
  • Male
  • Melanoma / secondary
  • Melanoma / therapy*
  • Middle Aged
  • Photochemotherapy / methods*
  • Photosensitizing Agents / therapeutic use
  • Skin Neoplasms / pathology
  • Skin Neoplasms / therapy*
  • Toll-Like Receptors / agonists*
  • Toll-Like Receptors / therapeutic use
  • Treatment Outcome


  • Aminoquinolines
  • Antineoplastic Agents
  • Photosensitizing Agents
  • Toll-Like Receptors
  • Imiquimod