This is a retrospective review of 12 patients with periocular lentigo maligna treated with topical 5% imiquimod cream. In six patients it was the only treatment, and in the other six it was used following partial excision, cryotherapy or both. It was applied daily with a 10mm margin beyond the apparent extent of the lesion. Erythromycin ointment was instilled into the eye immediately prior to treatment to help protect the ocular surface. Mean treatment duration was 3.9 months (range 1-10 months), but treatment holidays were allowed when the local skin reaction became severe. Redness and discomfort were common side-effects. Only one patient developed conjunctival chemosis, one a lower lid ectropion and one abandoned treatment after one month due to intolerable irritation. Apart from this patient all patients had complete resolution of their lentigo maligna, both clinically and histologically on repeat biopsy. Although this is a small retrospective series with an average follow-up of 1.5 years, it does provide further evidence for the efficacy and safety of imiquimod in periocular lentigo maligna.