Role of topical therapy: Imiquimod

The gold standard for treatment of lentigo maligna is complete surgical excision. Second-line non-surgical modalities include radiotherapy, laser therapy, and topical therapies. Evidence for the use of various topical agents, including tretinoin, azelaic acid, and 5-fluorouracil, is limited. The greatest evidence exists for imiquimod 5 % cream, which has been investigated in multiple case series and studies. Topical imiquimod appears to be effective in a subset of cases, but clinical response is unpredictable and guidelines for monitoring and follow-up remain to be established. As such, its role in the treatment of lentigo maligna remains controversial and additional studies with higher quality evidence are needed.