Treatment of Bowen's Disease with a Skin Lesion Smaller Than 2 cm at a Low-Risk Site
Clinical Scenario
This protocol addresses Bowen's disease (squamous cell carcinoma in situ) presenting as a skin lesion smaller than 2 cm, located at a low-risk anatomical site such as the trunk or limbs, in a patient who is not immunosuppressed.
Key Qualifying Conditions
Lesion size and site are central to management in this scenario. Small SCC in situ lesions (< 2 cm) at low-risk sites — the trunk and limbs — may be suitable for management in primary care. Lesions larger than 2 cm, or those at high-risk anatomical locations, fall outside this scenario.
Treatment Approach (partial overview)
Multiple first-line options are available for this scenario, including both topical and procedural modalities. The choice among them depends on clinical assessment and individual patient factors. The complete evidence-based regimen — including specific selection criteria for each option — is available via the link below.
Treatment Goal
Complete clearance of the SCC in situ lesion within 6 months.
References
DOI: 10.1093/bjd/ljac042
- SCC in situ that is small (< 2 cm) and at a low-risk site (such as the trunk and limbs) may be managed in primary care by a general practitioner who is capable of establishing a clinical diagnosis and initiating treatment options as per the guideline in the first instance.
- Lesions are considered large if > 2 cm and are considered high risk at periocular and digital (and penile) sites.
- Offer cryotherapy as a first-line treatment option to people with small (< 2 cm) SCC in situ lesions.
- Offer topical 5-fluorouracil (5%) monotherapy to people with SCC in situ, for small lesions (e.g. < 2 cm) in low-risk sites, and in those who will not or cannot undergo alternative treatments. Initiate a standard regimen of once- or twice-daily application for 3–4 weeks.
- Clearance (within 6 months).
View source ↗