Topical imiquimod to treat intraepidermal carcinoma.

An 82-year-old man with severe cardiac arrhythmia and recurrent heart failure presented with a 3-year history of erythematous plaques on the left orbita and on the chest. The lesion on his left eye was a hypertrophic actinic keratosis (231.5 cm), a scaly erythematous plaque on the saddle of the nose extending to the opening of the left lacrimal duct. The chest lesion consisted of a 532.5-cm plaque with a hemorrhagic crust that caused recurrent itching. On histologic examination, the epidermal cells in the lower epidermis were atypical and showed large, hyperchromatic nuclei and abnormal mitoses (Figure 1A). The biopsy specimen tested positive for human papillomavirus (HPV) type 33 using consensus primers and polymerase chain reaction.