A 61-year-old male presented with 20 x 15 mm diffuse, hyperpigmented lesion that covered the right upper eyelid and which had been present for 2 years. Lesion was diagnosed as actinic keratosis (AK). Since the patient refused surgery and reconstruction, he was treated with imiquimod (IMQ) 5% cream once a day, 5 times per week for 6 weeks. Lesion gradually reduced in size and no clinically evident residual keratosis was observed after treatment. No post-therapy excision was performed to assess histological clearance of AK for cosmetic reasons. Although surgery is first-line treatment for these lesions, in case of refusal to undergo surgery, when lesion is superficial and diffuse and in region where reconstruction would be difficult, treatment with IMQ may be preferred.Keywords: Actinic keratosis, Aldara, imiquimod.