This protocol applies to squamous cell carcinoma in situ (Bowen's disease) presenting as a large lesion located on the lower leg or another site with poor healing potential, in patients who are not immunosuppressed. The anatomical location introduces specific clinical constraints that distinguish this scenario from lesions at other sites.
Large lesion size at a poorly healing anatomical location — especially the lower leg — significantly limits which treatment modalities are appropriate. The lower leg is recognised as a site where certain standard radiation approaches carry a disproportionate risk of prolonged healing complications, making treatment selection more complex than at other anatomical locations.
In this specific setting, a radiation-based technique capable of conforming to curved body surfaces and accommodating the poor-healing characteristics of the lower leg is among the options considered — though it is classified as a less suitable alternative compared to other anatomical sites. The full structured protocol defines the complete selection criteria, alternatives, and clinical decision pathway.
DOI: 10.1093/bjd/ljac042
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.
Consider referring immunocompetent people with SCC in situ for consideration of brachytherapy to treat curved surfaces and areas of poor healing, such as the digit and lower legs.
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