From the Guidelines
Surgical excision with clear margins is the recommended treatment for squamous cell carcinoma (SCC) in situ on the cheek, as it provides both treatment and tissue for pathological confirmation, with Mohs micrographic surgery being a preferred option for facial lesions. The management of SCC in situ on the cheek involves several treatment options, including:
- Surgical excision with a 4-5 mm margin
- Mohs micrographic surgery
- Cryotherapy
- Curettage and electrodesiccation
- Topical 5-fluorouracil (5-FU) cream
- Imiquimod cream
- Photodynamic therapy
However, according to the most recent and highest quality study 1, topical therapies (imiquimod or 5-FU) and PDT are not recommended for the treatment of cSCC on the basis of available data. The study suggests that radiation therapy can be considered when tumors are low risk, and cryosurgery may be considered for low-risk cSCC when more effective therapies are contraindicated or impractical.
The choice of therapy for SCC in situ will be affected by patient and clinician access to therapy, patient preference for home-based vs. hospital-delivered therapies, and therapy cost to the patient and healthcare provider 1. The British Association of Dermatologists' guidelines for the management of squamous cell carcinoma in situ (Bowen's disease) 2014 also recommend topically applied 5-FU as a well-recognized treatment option for SCC in situ, with a typical regimen of once- or twice-daily application for 3–4 weeks, repeated if required 1.
Following treatment, regular follow-up examinations every 3-6 months for at least 2 years are essential to monitor for recurrence. Sun protection is crucial to prevent new lesions, including daily use of broad-spectrum sunscreen (SPF 30+), wearing protective clothing, and avoiding peak sun hours. SCC in situ (Bowen's disease) has excellent outcomes when treated appropriately, but without treatment can progress to invasive SCC, so prompt and complete treatment is important.
From the FDA Drug Label
3 Administration Instructions PDT is a multi-stage process: Step 1. Preparation of Lesions Before applying AMELUZ, carefully wipe all lesions with an ethanol or isopropanol-soaked cotton pad to ensure degreasing of the skin. Step 2. Application of AMELUZ Apply AMELUZ using glove protected fingertips or a spatula. Step 3. Occlusion for 3 Hours Cover the area where the gel has been applied with a light-blocking, occlusive dressing. Step 4 Illumination with Red Light For patient and medical personnel, wear suitable protective eyewear during illumination.
The management of squamous cell carcinoma (SCC) in situ on the cheek using aminolevulinic acid (TOP) involves a multi-stage process:
- Preparation of lesions: Degrease the skin with an ethanol or isopropanol-soaked cotton pad.
- Application of AMELUZ: Apply the gel to the lesions and surrounding healthy skin.
- Occlusion: Cover the area with a light-blocking, occlusive dressing for 3 hours.
- Illumination: Use a red light source, such as the BF-RhodoLED or RhodoLED XL lamp, to illuminate the treatment area. It is essential to follow the administration instructions carefully and take necessary precautions to avoid adverse reactions, such as hypersensitivity and increased photosensitivity 2.
From the Research
Management of Squamous Cell Carcinoma (SCC) In Situ on Cheek
- The management of SCC in situ on the cheek can be approached through various non-surgical methods, including topical therapies and destructive treatments 3, 4, 5, 6, 7.
- Topical 5-fluorouracil (5-FU) and imiquimod have been studied as monotherapies for the treatment of SCC in situ, with promising results, but long-term tumor-free survival rates are still less than with surgical management 3, 4.
- Combination topical therapy with imiquimod, 5-FU, and tretinoin, along with intermittent cryotherapy, has been shown to be effective in treating small, invasive SCC in select patients who defer surgery 3.
- For patients who have failed monotherapy with a topical agent for cutaneous SCC in situ, combination treatment using both topical 5-FU cream and imiquimod cream may be considered as an alternative therapeutic strategy 4.
- A systematic review and meta-analysis found that electrodessication and cryotherapy, in combination with curettage, are more effective than photodynamic therapy, 5-FU, or imiquimod in treating SCC in situ and SCC 5.
- Treatment options for SCC in situ should be individualized, considering the patient's situation and the fact that treatment protocols have not been fully defined for most non-surgical methods 6, 7.