A Comparative Study Examining the Management of Bowen’s Disease in the United Kingdom and Australia

Abstract

Background and Aim. The optimum management of Bowen's Disease (BD) is undefined. A review of current practice is required to allow the development of best practice guidelines. Methods. All BD cases, diagnosed in one UK centre and one Australian centre over a year (1 July 2012–30 June 2013), were analysed retrospectively. Patients with BD were identified from histopathology reports and their medical records were analysed to collect demographic data, site of lesion, and treatment used. Results. The treatment of 155 lesions from the UK centre and 151 lesions from the Australian centre was analysed. At both centres BD was most frequently observed on the face: UK had 70 (45%) lesions and Australia had 83 (55%) lesions (P = 0.08). The greatest number of lesions was managed by the plastic surgery department in the UK centre, 72 (46%), and the dermatology department in the Australian centre, 121 (80%). The most common therapy was surgical excision at both centres. Conclusions. In both UK and Australia, BD arises on sun-exposed sites and was most commonly treated with surgical excision despite a lack of robust evidence-based guidelines.

Bowen’s Disease- A Case Report of a Rare Carcinoma in Situ

“…(14) Surgical modality has been the most commonly used modality in both UK and Australia. (15) It is recommended for size and sites where it is convenient and has the benefit of being a rapid, easy and cost effective method. For lesions on face, genital and digital lesions, Mohs surgery can be considered if feasible.…”

“…The response is comparable to cryotherapy with the benefit of less pain and lower recurrence rates. (14,15) Cryotherapy with liquid nitrogen is a simple method of treatment with the advantage of accessibility in outpatient setting. The clearance rates to cryotherapy varies considerably.…”

“…(16) Photodynamic therapy with 5-aminolevulinic acid (ALA) or methyl aminolevulinate (MAL) has very good clearance rates of 93% even with single cycle, comparable to curettage, cryotherapy and 5-FU. (13,15,17) From currently available data, it has high level of evidence for its use in BD. It may be especially useful for larger lesions, difficult to treat or resistant sites such as the lower limbs.…”

“…It may be especially useful for larger lesions, difficult to treat or resistant sites such as the lower limbs. (15) Topical 5-fluorouracil 5% cream has shown clearance rates up to 92% in both short and longterm followup studies. Variable clearance rates are related to the different continuous and pulse therapy regimens of 5-FU.…”

“…It is generally well tolerated, may cause erythema and crusting. (15) The benefit of these topical agents is in difficult to treat areas and large lesions where surgical treatment is inconvenient. However, PDT is more efficacious in larger lesions.…”