Background: At present, case studies are the only source of results on imiquimod (IMQ) as monotherapy in cutaneous metastases from melanoma. We analyzed these studies in the literature with the aim to review the efficacy of IMQ as topical treatment for melanoma skin metastases. Objective: The aim of our review was to critically assess the studies evaluating the monotherapy with IMQ cream in the treatment of cutaneous metastases from melanoma.  Methods: A PubMed search was conducted using the term "melanoma" combined with "metastases" and "imiquimod". Results: 57 studies were identified. 46 did not meet inclusion criteria, leaving 11 case studies. Overall, 17 patients were treated in these 11 studies. Main treatment choice was 5% IMQ cream applied once daily (for 6-8 hours), five days per week under occlusive conditions, in 8/17 patients (47,1%). IMQ was applied 3 times weekly in 4/17 patients (23,53%), daily in 2/17 patients (11,76%) and twice daily in 2/17 patients (11,76%).

Treatment length was variable, with a mean duration of 22 weeks (range from 8 weeks to 72 weeks).

The majority of studies showed that IMQ is an effective and safe treatment for metastases of melanoma. Even if this treatment doesn't stop the disease progression, it is mainly useful in clearing cutaneous metastases spreading from melanoma primary tumor.