Treatment of Squamous Cell Carcinoma In Situ at a Challenging Site Where Tissue Conservation Is Important
Bowen's disease — squamous cell carcinoma (SCC) in situ — presents a particular management challenge when the lesion is located at an anatomically sensitive site such as the periocular region or the nail unit, where minimising tissue loss alongside complete clearance are both primary clinical objectives.
Clinical scenario
This protocol applies to non-immunosuppressed patients with SCC in situ at a challenging site where tissue conservation is important — specifically around the eyes or involving the nail unit. Lesions at these high-risk anatomical locations, particularly those larger than 2 cm, require a management approach that balances oncological adequacy with preservation of function and structure.
Treatment approach & goals
First-line management for this scenario involves a surgical modality selected for its capacity to achieve complete tissue clearance while respecting the anatomical constraints of the site. The clinical target is complete clearance of the SCC in situ lesion within 6 months. The specific preferred approach for this site, the margin guidance, and the full structured regimen are available via the link below.
References
DOI: 10.1093/bjd/ljac042
- Consider Mohs micrographic surgery in people with SCC in situ when tissue conservation is important, such as around the eyes and the nail unit.
- Lesions are considered large if > 2 cm and are considered high risk at periocular and digital (and penile) sites.
- 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).