Lentigo maligna, the in situ phase of lentigo maligna melanoma, is frequently located on the head, and surgical excision can be a formidable procedure. While surgical excision, either with conventional surgery or Mohs micrographic technique, remains the treatment of choice for lentigo maligna,1-3 sometimes surgical excision is not a viable option. A recent report4 described successful treatment using imiquimod cream on a large lentigo maligna on the scalp of an elderly man. Following this lead, I used imiquimod to successfully treat an extensive recurrent lentigo maligna in a 90-year-old woman.