From the Guidelines
Intradermal squamous cell carcinoma (SCC) will progress to cancer if left untreated. Intradermal SCC, also known as squamous cell carcinoma in situ or Bowen's disease, is a precancerous lesion that has the potential to progress to invasive squamous cell carcinoma if left untreated, as noted in the guidelines for the management of cutaneous squamous cell carcinoma 1. This progression occurs as abnormal cells confined to the epidermis eventually break through the basement membrane and invade the dermis.
Treatment Options
Treatment is necessary and typically involves:
- Surgical excision
- Cryotherapy
- Topical chemotherapy (such as 5-fluorouracil)
- Photodynamic therapy
While 5-FU can be used topically, it is not typically injected (option b is incorrect), as indicated by the british association of dermatologists' guidelines for the management of squamous cell carcinoma in situ (Bowen's disease) 2014 1. These lesions should not be left alone without monitoring (option c is incorrect) due to their malignant potential.
Risk Factors
Regarding option d, intradermal SCC is not typically familial but is more commonly associated with:
- Cumulative sun exposure
- HPV infection
- Immunosuppression
- Exposure to certain chemicals or radiation, as discussed in the guidelines of care for the management of cutaneous squamous cell carcinoma 1.
The most appropriate course of action is to treat intradermal SCC to prevent progression to invasive cancer, considering the potential risks and benefits of each treatment option, as outlined in the guidelines for the management of cutaneous squamous cell carcinoma 1.
From the Research
Intradermal SCC Treatment Options
- Intradermal SCC will not always progress to cancer, but it can be a precursor to more invasive forms of the disease 2.
- Injecting 5FU (5-fluorouracil) is a treatment option for certain cases of SCC, particularly for patients who are not good candidates for surgical excision 3, 4.
- Leaving intradermal SCC alone and not monitoring it is not a recommended course of action, as it can potentially progress to more invasive disease 5, 2.
- There is no clear evidence to suggest that intradermal SCC is often familial, although certain genetic factors can increase the risk of developing skin cancer 5, 2.
Treatment Efficacy
- Topical 5FU has been shown to be an effective treatment for certain cases of cutaneous squamous cell carcinoma in situ (cSCCis), particularly for smaller lesions 4.
- Imiquimod cream 5% has also been used as a topical treatment for cSCCis, although its efficacy may be lower than that of 5FU, particularly for larger lesions 4, 6.
- Combination therapy with 5FU, imiquimod, and tretinoin has been shown to be effective in treating certain cases of invasive SCC, although more research is needed to fully understand its efficacy 3.