Lentigo maligna (LM) is a pigmented lesion that occurs most commonly on the sun-exposed skin of the head and neck of an older patient. LM can be difficult to completely remove due to its occasional extensive subclinical extension. Surgical treatments, including standard excision and margin-controlled excision (Mohs micrographic surgery or rush permanent sections), are reviewed. Immunostains that can increase sensitivity and specificity of margin-controlled excision are discussed, and other nonscalpel treatments including destruction, topical imiquimod, radiation therapy and cryotherapy are briefly discussed. The gold standard treatment for LM is margin-controlled excision.