مرض بوين مع آفة كبيرة (أكبر من 2 سم) في موضع منخفض الخطورة بعد عدم تحقيق علاج الخط الأول للإزالة التامة

References

DOI: 10.1093/bjd/ljac042

• Lesions are considered large if > 2 cm and are considered high risk at periocular and digital (and penile) sites.
• Consider curettage with cautery on an individual basis in people with SCC in situ with larger lesions. Consider patient factors (age, location, skin health) and discuss the risk of prolonged healing and potential ulceration.
• Consider cryotherapy on an individual basis, in people with SCC in situ with larger lesions, and those on the lower leg (see R15).
• Offer* standard surgical excision to people with SCC in situ where morbidity from surgery is low, or for recurrent or refractory disease. Use an appropriate clinical margin to achieve complete clearance. Depending on the anatomical location and clinical assessment, a 3–5-mm margin may be preferable (see Appendix C).
• Consider topical imiquimod (5%) in people with SCC in situ at low-risk sites, when there is no suitable alternative. Consider once-daily application, three times per week for 4 weeks, although prolonged treatment for 12 weeks may be required.
• Refer* immunocompetent people with SCC in situ for consideration for radiotherapy only where the lesion is recurrent or refractory to other treatments, or where surgery is not appropriate or is associated with high morbidity.