Treatment of lentigo maligna with imiquimod 5% cream

Lentigo maligna (LM) is an in situ melanoma that occurs in sun-damaged skin on the head and neck of elderly patients. Surgical excision is the treatment of choice for LM. However, surgical options may be limited by the location of LM in cosmetically sensitive areas. We present a woman with a history of skin cancer with a large, asymmetrically pigmented lesion on her right superior cheek below her eyelid. The lesion had been present for approximately 15 years. Histologic analysis confirmed that the lesion was an LM. Imiquimod 5% cream was applied topically once daily. Approximately 5 months later, the previous LM had healed well and no new lesions were observed. Histologic clearance of the lentigo maligna was evident in skin biopsies. Imiquimod 5% cream appears effective in the treatment of lentigo maligna. We describe the treatment of a patient with facial LM with imiquimod 5% cream.