Bowen Disease — SCE Dermatology MCQ

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EasySkin CancerBowen DiseaseSCE Dermatology

A 55-year-old man has Bowen disease (SCC in situ) on his lower leg. The plaque is 2 cm in diameter on non-hair-bearing skin. He is not a surgical candidate. What are the non-surgical treatment options?

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Correct answer: B — Topical 5-fluorouracil 5% cream, topical Imiquimod 5% cream, photodynamic therapy, or cryotherapy

For Bowen disease (SCC in situ) when surgery is not feasible, multiple non-surgical options are available per BAD guidelines: (1) topical 5-FU 5% cream (applied BD for 3-4 weeks or once daily for 6-8 weeks); (2) topical Imiquimod 5% cream (applied once daily 5 days/week for 6-16 weeks); (3) PDT with methyl aminolaevulinate (two treatments 1 week apart); (4) cryotherapy (two freeze-thaw cycles). Choice depends on lesion site, size, patient preference, and availability. 5-FU has the highest clearance rates. PDT provides best cosmesis. Cryotherapy is appropriate for smaller lesions. All require follow-up to confirm clearance (biopsy if concern about recurrence).

Reference: BAD 2014 Bowen Disease Guidelines; NICE