How do you decide when to recommend non-surgical management of Bowen's disease in light of long-term data showing very low risk of invasive cSCC after treatment with 5-FU as compared to surgical excision?

Generally, this is a low-risk lesion that can be treated effectively by a variety of modalities or, in some cases, not treated.

However, one should always bear in mind that a biopsy may not truly represent the full extent of the lesion. One of the worst invasive SCCs I’ve observed was initially read...

If it is a small squamous cell carcinoma (SCC) in situ, less than 1 cm, I will use imiquimod 5% cream once daily for 3 to 4 weeks, or even electrodesiccation and curettage. Larger lesions or ones in hairy areas like the forearms in males are usually excised.