Bowen's disease — squamous cell carcinoma (SCC) in situ — presents distinct management challenges when it occurs in an immunosuppressed patient. The immune status of the patient directly affects which treatment options are appropriate, which should be reserved for specific circumstances, and how to approach multiple or recurring lesions.
This protocol applies to patients with SCC in situ (Bowen's disease) in the setting of immunosuppression. Immunocompromised individuals are at higher risk of malignant progression, and the pattern of lesion occurrence — including multiple or recurring lesions — is an important factor in determining the appropriate management path.
In this immunosuppressed setting, certain treatment modalities are considered less suitable as routine options. Specifically, some interventions are reserved only for circumstances in which disease has advanced beyond SCC in situ — and cannot be applied repeatedly at the same anatomical location. The full structured regimen, including which approaches are preferred at this stage, is available via the protocol below.
For immunosuppressed people, reserve radiotherapy for where the SCC in situ has progressed to invasive disease. Such patients are at higher risk of malignancy, and radiotherapy cannot be used multiple times at the same location.
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