Surgery for Bowen Disease: Clinicopathological Factors Associated With Incomplete Excision

Abstract

Background: One common treatment for Bowen’s disease (BD) is surgical excision, but there is no international consensus on the appropriate surgical margins.
 Objectives: This study examined what factors affect the rate of incomplete excision of BD.
 Methods: Clinicopathological data potentially linked to surgical outcome (complete or incomplete excision) were retrospectively collected from medical and histopathological records on all surgically excised BD lesions diagnosed at Sahlgrenska University Hospital in Gothenburg, Sweden during 2014-2015. Data were analyzed with two definitions of incomplete excision: less strict (ie, BD present at the surgical margin) and strict (ie, dysplasia present at the surgical margin).
 Results: In total, 463 BD lesions among 408 patients were included. With the less strict definition, 3 factors were associated with significantly higher rates of incomplete excision: surgical margins <3 mm, a less experienced surgeon, and use of punch biopsy excision. The same factors plus a tumor location on the head and neck area or upper extremities were associated with significantly higher rates of incomplete excision using the strict definition. After adjustment for confounders, less experience was independently associated with incomplete excision using the less strict definition, whereas less experience and location on the head and neck area or upper extremities were independently associated with incomplete excision using the strict definition. Surgeon specialty was not associated with incomplete excision regardless of the definition.
 Conclusions: When removing BD surgically, an elliptical excision with surgical margins ≥3 mm carried out by an experienced surgeon should be recommended. Surgical margins may need to be adjusted depending on body site.

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“…Few studies have compared the effectiveness of cryosurgery and/or curettage with other common treatment modalities for IEC such as surgical excision, PDT, 5% 5‐FU cream and ablative laser therapy 16,24,25 . Excisions have been shown to be incomplete in 12.8%–23.8% 26,27 and other studies show recurrence rates of 0.8%–5.5% after 5 years. Complete response rates after PDT range from 52% to 100% and recurrence rates vary between 0% and 46% with varying times to FU and numbers of PDT sessions 17,24,28–31 .…”

Knowledge and awareness about Bowen's disease among dental students

“…[ 5 ] The specific treatment relies on many factors, including affected body area; size, thickness, and the number of lesions; with or without specific symptoms; age and health status of the person; and/or other factors. [ 6 ] Based on the case history and careful consultation, the specific medication and/or other decisions regarding the use of specific medications be selected for this disease. Detailed discussion regarding the possible benefits and risk factors including potential side effects and long-term effects is essential.…”