Bowen's disease (squamous cell carcinoma in situ) presenting in a patient with immunosuppression. Immunosuppressed individuals represent a distinct sub-population requiring particular care in lesion management, given altered treatment response and the practical challenges of multiple or recurring lesions.
This protocol applies after first-line treatment has been attempted but has not achieved complete clearance of the SCC in situ lesion within 6 months.
First-line options that may have been used: topical 5-fluorouracil, conventional photodynamic therapy, cryotherapy, curettage with cautery, or standard surgical excision.
When the above first-line measures have not achieved clearance, secondary options involving either a laser-based intervention or a topical immune-response modifier may be considered. The choice of approach and the conditions under which each is appropriate — including specific considerations for immunosuppressed patients — are detailed in the full protocol.
Consider topical 5-fluorouracil (5%) in immunosuppressed people with SCC in situ, as a practical treatment for multiple and recurring lesions.
For immunosuppressed people, reserve radiotherapy for where the SCC in situ has progressed to invasive disease.
Where this service is available, consider laser treatment in people with SCC in situ where other treatments have failed or are not suitable. Ablative CO2 laser may be more effective than nonablative neodymium:YAG.
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. A reduction in efficacy may be observed in those who are immunosuppressed.
DOI: 10.1093/bjd/ljac042
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