Single skull lesions of the frontal, parietal, or occipital regions, or single lesions of any other bone

Curettage. Curettage only is the recommended therapy, when possible, for isolated bone lesions. Curettage plus injection of methylprednisolone may also be used. LCH bone lesions do not need complete excision because this may increase healing time and the risk of long-term complications. Complete excision of skull lesions, which may require grafting, is not necessary.

Low-dose radiation therapy. Local radiation therapy could be considered for an isolated lesion.[94,96][Level of evidence C3] Low-dose radiation therapy (7–10 Gy) is effective,[95,97] but its use is limited in pediatric patients to lesions that threaten organ function or are painful and not amenable to other therapies.[98,99]; [100][Level of evidence C1] In a single-institution study of 39 patients with LCH (age range, 1.5–67 years; 15 patients aged <18 years) who received radiation therapy to 46 lesions, there were no local recurrences in the 31 bony sites (median radiation therapy dose, 10.8 Gy; range, 7.5–24 Gy), and the freedom from local failure rate was 63% at 3 years in the 15 nonbone lesions (95% confidence interval, 32%–83%; P = .0008). In this study, no subsequent cancers occurred,[94] although subsequent cancers have been previously reported.[101] Skeletal complications are uncommon after the low doses that are used, but they can occur.[96]