Imiquimod, an immune response modifier, is marketed as Aldara 5% cream (Meda) and licensed for treating adults with small superficial basal cell carcinomas (BCCs).1 Numerous uses outside the licensed indications (i.e. 'off-label') have been proposed and practised, including as treatment for pre-cancerous conditions such as Bowen's disease (squamous cell carcinoma in situ) and lentigo maligna (an in situ precursor of melanoma).2,3 Here we review the use of imiquimod for small superficial primary BCC in adults, Bowen's disease and lentigo maligna.