To the Editor We read with great interest the article by Nichols et al1 regarding the use of combined systemic and intratumoral human papillomavirus (HPV) vaccine to treat a woman in her 90s with multiple cutaneous squamous cell carcinomas. This article drew our attention because of the difficulties encountered in the management of such lesions in elderly patients. In the reported case, it seems clear that neither surgery nor chemotherapy would have been suitable for the patient.