146 Letters J AM ACAD DERMATOL

JANUARY 2002

Topical imiquimod 5% cream in the treatment

of Bowen’s disease of the penis
To the Editor: We read with interest the article by
Mackenzie-Wood et al1 (J Am Acad Dermatol
2001;44:462-70). They reported treatment of large-
J AM ACAD DERMATOL Letters 147
VOLUME 46, NUMBER 1

diameter lesions of Bowen’s disease with topical Fran Cook-Bolden, MD

imiquimod 5% cream. In their study, 16 patients with Jeffrey M. Weinberg, MD
Bowen’s disease lesions ranging from 1 to 5.4 cm in Department of Dermatology
diameter (0.7-21.6 cm2 in area) were treated. Fifteen St Luke’s-Roosevelt Hospital Center
of the lesions were on the legs, and one was on the 1090 Amsterdam Ave, Suite 11D
shoulder. We now report successful treatment of New York, NY 10025
Bowen’s disease of the penis with topical imiquimod E-mail: jwein@bway.net
5% cream. Correspondence to Dr Weinberg
A 47-year-old white man presented with a 2.5 × 1.5
cm erythematous plaque on the dorsal surface of the REFERENCES
1. Mackenzie-Wood A, Kossard S, de Launey J, Wilkinson B, Owens
penile shaft. A biopsy was performed, and histo-
ML. Imiquimod 5% cream in the treatment of Bowen’s disease.
pathologic examination revealed squamous cell car- J Am Acad Dermatol 2001;44:462-70.
cinoma in situ. Therapy was initiated with once-daily 2. Smith KJ, Germain M, Skelton H. Bowen’s disease (squamous
application of imiquimod 5% cream to the lesion. cell carcinoma in situ) in immunosuppressed patients treated
The patient noticed some irritation after 2 weeks of with imiquimod 5% cream and a COX inhibitor, sulindac: poten-
treatment. After a rest period of 1 week, the patient tial applications for this combination of immunotherapy.
Dermatol Surg 2001;27:143-6.
resumed daily application of the imiquimod. 3. Pehoushek J, Smith KJ. Imiquimod and 5% fluorouracil therapy
At 6-week follow-up, there was a slight decrease in for anal and perianal squamous cell carcinoma in situ in an HIV-
the size of the plaque, with mild desquamation and 1-positive man. Arch Dermatol 2001;137:14-6.
erythema in the surrounding area. Two weeks later, 4. Beutner KR, Geisse JK, Helman D, Fox TL, Ginkel A, Owens ML.
the lesion on the penis appeared completely resolved. Therapeutic response of basal cell carcinoma to the immune
response modifier imiquimod 5% cream. J Am Acad Dermatol
The patient then discontinued the imiquimod. The 1999;41:1002-7.
patient returned at week 14 for re-evaluation. Four 5. Kagy MK, Amonette R. The use of imiquimod 5% cream for the
biopsies were performed from the former area of the treatment of superficial basal cell carcinomas in a basal cell
tumor, revealing fibrosing granulation tissue and no nevus syndrome patient. Dermatol Surg 2000;26:577-8.
residual tumor. Three months after the posttreatment Published online Aug 29, 2001
biopsy, there was no clinical evidence of recurrence.
Our case is the fourth successful report of 16/8/119103
doi:10.1067/mjd.2001.119103
imiquimod 5% cream in the treatment of Bowen’s
disease, and the first on the penis. In the report by
Mackenzie-Wood et al,1 14 of the 15 patients (93%
per protocol analysis) had no residual tumor present
in their 6–week posttreatment biopsy specimens.
One patient died of unrelated intercurrent illness
before a biopsy specimen could be obtained.
Smith, Germain, and Skelton2 recently reported
successful treatment of Bowen’s disease in 5
patients with chronic lymphocytic leukemia treat-
ed with imiquimod 5% cream and sulindac, a
COX-2 inhibitor. Pehoushek and Smith3 reported
imiquimod and 5-fluorouracil therapy for anal and
perianal squamous cell carcinoma in situ in an HIV-
1-positive man, and successful treatment of basal
cell carcinoma has been reported with the use of
topical imiquimod 5% cream.
These case reports and our case indicate that
imiquimod 5% cream is effective for treatment of
Bowen’s disease of various regions of the cutaneous
surface, including the head and neck, extremities,
and anogenital area. The 93% positive treatment
response in biopsy-confirmed cases in the report
by Mackenzie-Wood et al1 compares favorably with
other current treatment modalities. The dosing
schedule and length of treatment for Bowen’s dis-
ease require further evaluation.