Abstract

Lentigo Maligna (LM) is a melanoma in situ on sun-exposed facial skin in the elderly. Although surgery is the standard treatment, anatomical and aesthetic concerns may limit its use: Imiquimod, a topical immune modulator, offers a non-surgical alternative. A 64-year-old woman with a 3 cm × 2 cm LM on the nasal dorsum refused surgery. Off-label treatment with 5% Imiquimod (five times weekly for 12 weeks) was started, and inflammatory reactions indicated an active immune response. Four weeks after finishing the treatment, a partial clinical improvement of the lesion was noted. At six months, no recurrence was observed, with excellent aesthetic and clinical outcomes. This case highlights Imiquimod’s potential as a non-surgical alternative for LM in difficult-to-treat areas, emphasizing the importance of careful patient selection and close monitoring.