The following pictures show a man who was facing mutilating surgery to remove a large area of Bowen’s disease from the ear. The diagnosis was confirmed by biopsy. Bowen’s disease should not be left untreated because there is a risk of it turning into a squamous cell carcinoma (SCC). SCCs that arise in Bowen’s disease can metastasize and kill the patient. In addition SCCs that arise on the ear are more likely to metastasize than those that arise on other parts of the body.

The patient had a good response to therapy and there was no evidence of recurrence up to 18 months later. He will be regularly reviewed for at least another 4 years.

Bowen's Disease (SCC in situ)

After 4 weeks of therapy

Imiquimod has been used to treat basal cell carcinomas (BCC) and it is most effective for thin BCCs. It clears about 80% of thin BCCs but only about 60% of thicker, cystic BCCs. These results are for brief periods of follow-up and the recurrence rate after the use of imiquimod may be higher the longer the patients are followed.

This has to be compared to other forms of treatment. Excising a BCC will cure about 95% of cases, whereas radiotherapy will cure about 88% of cases. On the other hand, the scar caused by imiquimod may be less obvious than that caused by surgery or radiotherapy.

Before imiquimod is used to treat a suspected skin cancer, the diagnosis must be confirmed by a skin biopsy. This is because melanomas can sometimes look like basal cell carcinomas.