This protocol addresses squamous cell carcinoma in situ (Bowen’s disease) presenting as a large lesion on the lower leg or another anatomical site with poor wound-healing potential, in patients who are not immunosuppressed.
Large SCC in situ lesions on the lower leg or similarly challenging sites present specific management considerations. Poor healing potential at these locations limits which interventions are appropriate and directly influences the choice of approach — not all treatment modalities are suitable for this anatomical context.
Several first-line options are available for this scenario, encompassing topical therapy, light-based treatment, and procedural interventions — with selection guided by lesion size, site characteristics, and individual patient factors.
Complete clearance of the SCC in situ lesion within 6 months.
DOI: 10.1093/bjd/ljac042
Consider topical 5-fluorouracil (5%) monotherapy in people with SCC in situ, for larger lesions on poorly healing sites (e.g. the lower legs of older patients) as a practical alternative to surgical treatments. Initiate a standard regimen of once- or twice-daily application for up to 4 weeks (see R9).
For immunocompetent people with SCC in situ lesions located on the lower legs, use treatments other than radiotherapy (apart from brachytherapy), due to prolonged healing time.
Offer conventional, red-light PDT as a treatment option to people with SCC in situ, particularly for poorly healing or cosmetically sensitive skin sites, multiple lesions and large lesions.
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 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.
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.
Clearance (within 6 months).
View source ↗