A 76 year-old man presents for his biannual total body skin examination. He has had many prior nonmelanoma skin cancers and one melanoma in-situ. The asymptomatic lesion depicted is discovered on his left ankle.
Key point: Absent a history of papulosquamous skin disease, such as psoriasis, a solitary, well-demarcated, bright red scaly patch should suggest either superficial basal cell carcinoma or in-situ squamous cell carcinoma. In this case, a small biopsy established the correct diagnosis: squamous cell carcinoma in-situ (Bowen’s disease, SCCIS).
Treatment: While this lesion could be relatively easily removed by standard elliptical excision, fairly significant distal lower extremity edema was present from venous insufficiency. This posed a risk for slow postoperative healing and/or infection. Therefore, the SCCIS was treated by daily application of 5% imiquimod(Drug information on imiquimod) cream for 8 weeks. Associated with a substantial inflammatory response, the tumor resolved. After treatment cessation and frequent application of a bland ointment, the treated area healed promptly and with a good cosmetic outcome.
Note: Although imiquimod is not FDA-approved for the treatment of any type of squamous cell carcinoma, SCCIS may respond quite well to this modality.
