Introduction/Background Imiquimod is an immune response modulator often used in the management of various clinical manifestations of human papillomavirus (HPV) infection. The aim of this case report is to present a possibility of non-surgical, pharmacotherapeutic approach with 5% imiquimod as an appropriate alternative to surgical procedures in selected patients with cervical premalignant lesions.

Results A 50-year-old female presented with cervical stump high grade squamous intraepithelial lesion (HSIL), seven years after laparoscopic supracervical hysterectomy. Current guidelines recommend surgery as preferable treatment modality for histologically confirmed cervical HSIL, after 6 months follow-up Pap test. Initial approach to management of patients with cervical stump HSIL must consider treatment-related morbidity. The goal of treatment is to prevent disease progression to invasive disease. Nonsurgical medical therapy with topical imiquimod appears to be more effective than no treatment, inducing regression of the disease in 73%, versus 50%. Considering these data, after biopsy and during 6 months’ period of follow-up, we decided to initiate imiquimod therapy until the follow-up Pap test. Imiquimod treatment was started with self-applied vaginal imiquimod suppositories three times weekly, for 16 weeks. Follow-up Pap test conducted after the completion of therapy was negative for intraepithelial lesion or malignancy. All subsequent Pap smears, HPV testing and colposcopy findings in last five years came negative. Therefore, we were able to avoid further surgical treatment in this patient.

Conclusion Topical medical therapy with 5% imiquimod of cervical premalignant lesion, at this point, cannot replace surgical therapy but may be considered as an off-label treatment option for selected group of women who want to avoid further surgery, especially during standard observation after primary biopsy, as shown in our report.

Disclosures The authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest or nonfinancial interest in the subject matter or materials discussed in this manuscript.