History:

 Insidious onset of asymptomatic 1.5cm patch on upper, anterior chest. Patient is retired but favors gardening, which has done for decades without a shirt. Biopsy showed classic squamous cell carcinoma, in-situ (Bowens Disease). Patient treated off-label with topical imiquimod 3.75%, five days weekly, for 12 weeks. Brisk crusting, and eventually almost nothing. Excellent response, but will require close followup.