Dermatology Online Journal

The use of imiquimod 5% cream, a topical immunomodulator for the treatment of lentigo maligna (LM) was first described in 2000. Subsequent studies have indicated that imiquimod might be an effective nonsurgical treatment in patients who refuse to have, or are ineligible for surgery because of comorbidities, tumor size, or risk of cosmetic disfigurement. Herein, we outline our experience with treating LM on the nose in an 88-year-old skin cancer patient with significant comorbidities. Given our patient's strong preference against surgical intervention, he was treated with topical imiquimod cream applied once daily for a total of 12 weeks. A two-week treatment holiday was required for severe nausea and vomiting, treated effectively with ondansetron wafers. There were no clinical or dermoscopic signs of LM recurrence 12 months posttreatment. Topical imiquimod is an effective alternative to excision in nonsurgical candidates.