Recommendations for the future

• New topical therapies should be assessed in the context of well-designed clinical trials comparing them with topical mechlorethamine.

• The role of new immunotherapies and retinoids in early stage (IB/IIA) disease should involve comparative RCTs with standard therapies such as PUVA.

• TSEB therapy with or without adjuvant immunotherapy and chemotherapy should be reserved for patients with late stages of disease, preferably in the context of clinical trials.

• There is an urgent need for more effective therapy for late-stage disease and this should be based on appropriate RCTs involving new immunotherapies, adjuvants, single- and multi-agent chemotherapies and both (mini)allogeneic and autologous transplants in selected individuals.

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