From the Guidelines
Treatment options for Squamous Cell Carcinoma In Situ (SCCIS) in the pretibial region are primarily non-surgical, with Photodynamic Therapy (PDT) being a highly effective option.
Treatment Options
- PDT: has a high strength of recommendation (A) and is considered particularly beneficial for lesions on the lower leg, with complete clinical clearance rates of 88–100% reported 3 months after one cycle of MAL-PDT 1.
- 5-Fluorouracil: is a commercially available 5% cream, with a strength of recommendation of B, and is more practical than surgery for large lesions, especially at potentially poor healing sites 1.
- Cryotherapy: is a simple, inexpensive, and quick method of treating SCC in situ, with a strength of recommendation of B, but may cause discomfort and ulceration, especially on the lower leg 1.
- Excision: is a simple, rapid, and effective treatment for SCC in situ of limited size, but cosmetic outcome, body site, healing properties, and vascularity of the area need to be considered, with a strength of recommendation of C 1.
Considerations
- Lesion characteristics, such as size and location, should be taken into account when choosing a treatment option.
- Patient factors, such as age and immune status, should also be considered.
- The potential for poor healing at the affected site should be assessed, with options like PDT being more suitable for such cases.
- Regular use of an emollient, especially one containing urea, can reduce scaling and make the lesion less obvious in cases where no treatment is chosen 1.
From the Research
Treatment Options for Squamous Cell Carcinoma In Situ (SCCIS) in the Pretibial Region
- Surgical excision: considered the gold standard treatment for SCCIS, with the lowest recurrence rate of 0.8% 2
- Cryotherapy: a less-invasive treatment modality with a recurrence rate of 4.7% 2
- Photodynamic therapy: a less-invasive treatment modality with a recurrence rate of 18% 2
- Curettage with cautery: a treatment option with no specified recurrence rate in the provided studies
- Radiotherapy: a treatment option with no specified recurrence rate in the provided studies
- Topical 5-fluorouracil: a treatment option with no specified recurrence rate in the provided studies
- Topical imiquimod: a treatment option with no specified recurrence rate in the provided studies
- Laser ablation: a treatment option with no specified recurrence rate in the provided studies
- Mohs micrographic surgery: a treatment option that may be deemed inappropriate or uncertain for SCCIS in non-immunosuppressed patients 3
- Local destruction: a treatment option with no significant difference in patient-reported outcomes compared to excision and topical therapy 4
- Topical therapy: a treatment option with no significant difference in patient-reported outcomes compared to excision and local destruction 4
Considerations for Treatment of SCCIS in the Pretibial Region
- Location of the tumor: treatment of SCCIS on the lower leg can be challenging due to poor wound healing in the setting of suboptimal circulation 5
- Patient preference: therapeutic selection can be based on the relevant clinical context and patient preference 4
- Risk of recurrence: recurrence rates vary depending on the treatment modality, with surgical excision having the lowest recurrence rate 2