rcinoma (SCC) is the second most common skin cancer. In particular, invasive SCC has a high risk of metastasis and sometimes, this can be fatal. At present, the treatment of choice for invasive SCC is complete excision with a proper surgical margin, but most cases of SCC develop on cosmetically-sensitive areas, so sometimes significant scarring or deformities can lead to an unhappy result. An 80 year-old female presented with a 4×1.5cm sized SCC on her lower lip. Although surgery was the first line therapy for this invasive SCC, a cosmetically poor outcome was expected. Thus the patient did not want to undergo a surgical operation, so we had to explore other treatment options. Recently there have been many reports that show imiquimod 5% cream is effective in the treatment of invasive SCC. Therefore we started topical therapy with imiquimod 5% cream five times a week. After 6 months, the lesion size was reduced to 2×1.5cm and we could remove the remnant tumor by wedge resection with cosmetically acceptable result. We suggest this neo-adjuvant immunotherapy can be an alternative for the treatment of cosmetically-critical SCC and present this case as a good example that has shown successful size-reductive neoadjuvant immunotherapy using imiquimod in invasive SCC.