Treatment of Bowen's Disease: Small Skin Lesion (<2 cm) at a Low-Risk Site (Trunk or Limbs)
This protocol covers squamous cell carcinoma in situ (Bowen's disease) presenting as a small lesion — under 2 cm — at a low-risk anatomical location such as the trunk or limbs, in a patient who is not immunosuppressed.
Clinical scenario: SCC in situ with a lesion smaller than 2 cm, located on the trunk or limbs (low-risk site), in a non-immunosuppressed patient. Lesions of this size and site are amenable to primary care management by a clinician capable of establishing a clinical diagnosis.
Therapeutic approach: When single-modality treatment is not sufficient or appropriate, combination therapy — pairing two distinct modalities in sequence — is the structured next step. Several two-modality combinations are defined in the full protocol. Specific options, sequencing, and the complete regimen are available below.
References
DOI: 10.1093/bjd/ljac042
- Offer* cryotherapy as a first-line treatment option to people with small (< 2 cm) SCC in situ lesions (see R15).
- Lesions are considered large if > 2 cm and are considered high risk at periocular and digital (and penile) sites.
- 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.
- Consider combination therapy if monotherapy with 5-fluorouracil (5%), imiquimod (5%), PDT, laser, cryotherapy, or curettage with cautery fails, and surgery is not appropriate or is associated with excessive morbidity (Table 2).