Imiquimod is a Toll like receptor (TLR) 7 agonist that acts on the immune system by stimulating the monocytes, macrophages and dendritic cells to produce interferon alpha, Th1 cytokines (IL-1, IL-6, IL-10, IL-12), tumor necrosis factor a and G-CSF, thereby counteracting Th2 cytokines and promoting tumor surveillance.5 It also enhances the activity of natural killer cells and epidermal Langerhan's cells. Here, TNF is linked to neoplasm.