The composition was based on what I found most appealing about the depicted story: the connection between Walt and the creature. A connection that grows stronger along with the stain.
On the back, the stain appears alone. On the cover, opposing representations of the same man. The stain, growing in shape and strength, moves through the composition, becoming a part of him.
The title placement relates to the way they connect, while the author name is located where most of the horror takes place.