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Fluconazole is considered the recommended systemic treatment for extensive tinea versicolor, primarily due to its effectiveness against Malassezia, the yeast responsible for this skin condition. Tinea versicolor, also known as pityriasis versicolor, occurs when Malassezia proliferates on the skin, leading to discolored patches.

Fluconazole works by inhibiting the synthesis of ergosterol, an essential component of fungal cell membranes. This action disrupts the integrity of the fungal cells, ultimately leading to cell death and a reduction in the fungal load, which is crucial in managing extensive cases that do not respond adequately to topical treatments.

In contrast, while other treatments like oral terbinafine and oral griseofulvin can be effective for different types of fungal infections, they are not typically the first-line options for tinea versicolor. Topical clotrimazole is useful for mild cases but lacks the systemic action required for treating extensive infections. Thus, fluconazole's efficacy and mechanism align well with the treatment needs for extensive tinea versicolor, making it the preferred choice.