The following treatments may be used for SCC in situ (Bowen’s disease or intraepithelial squamous cell carcinoma) and early-stage keratinocyte cancer when surgery is not suitable. The following treatments should be compared with surgery when discussing the likelihood of cure with the patient:

• curettage (with collection of a sample for histopathology) and electrocautery for well-defined, superficial or small nodular primary BCCs, SCC in situ and for selected low-risk SCCs where excision is not feasible
• cryotherapy for SCC in situ and early-stage superficial BCCs
• 5-fluorouracil cream for multiple solar keratoses and SCC in situ
• imiquimod cream for biopsy-proven superficial BCCs, multiple solar keratoses and SCC in situ
• photodynamic therapy for multiple solar keratoses, SCC in situ and selected cases of superficial BCC
• oral acitretin as an antiproliferative agent as chemoprophylaxis for post–solid organ patients with multiple previous SCCs.

Timeframes for starting treatment

Treatment should start as soon as diagnosis and staging has occurred, and the treatment modality becomes available, ideally within four weeks of the MDM.