OBJECTIVES Due to their commonality, basal cell carcinoma can be an expensive cancer to manage. Imiquimod is an effective treatment for superficial basal cell carcinoma (sBCC) though cost efficacy studies are lacking. This study compared the costs of management approaches for superficial basal cell carcinoma from a third party perspective at 1 and 5 years. METHODS A decision analytic model was developed that compared cost of imiquimod treatment versus commonly used surgical interventions including surgical excision and simple excision, curettage and electrodesiccation(ED & C). A United States third party payer perspective was used for the analysis.Published recurrence rates and Medicare reimbursement rates were used for modeling and sensitivity analyses. RESULTS The expected five-year modeling for imiquimod revealed a cost of US $1438 compared to $1074 and $888 for simple excision and ED& C respectively. Sensitivity analysis using probability of recurrence had little impact on the base case cost modeling with imiquimod falling between ED & C and simple excision. CONCLUSIONS The overall cost of therapy of sBCC by topical imiquimod was slightly higher compared to the common office-based surgical treatments. Preferences for number of visits, cosmetic outcome, risks of surgery, side effects of topical treatment all need to be considered on an individual basis.