Topical 5-Fluorouracil in the Management of Extensive Anal Bowen's Disease: A Preferred Approach

Abstract

Topical 5 percent 5-fluorouacil therapy is a safe and effective method to treat anal Bowen's disease. Wide local excision is appropriate for smaller, isolated areas of disease. Anal Bowen's disease was not associated with colonic or other neoplasms.

Wide local excision for Buschke-Löwenstein tumor or circumferential carcinoma in situ

“…A survey of the American Society of Colon and Surgeons members revealed that local excision is the preferred treatment for the majority of patients with perianal Bowen's disease [9]. There are numerous reports in the literature supporting that such approach is safe [9,10,12,13,26,27]. However, the inability to permanently eradicate the disease due to the persistence of HPV remains one of the biggest challenges of treating neoplastic anal lesions, especially in immunocompromised individuals [10,11,25,26,30].…”

“…However, there is little guidance as to the optimal management of Buschke-Löwenstein tumor because of its rarity [4][5][6][7][13][14][15][16][17][18][19][20][21][22]. Furthermore, the management of AIN is evolving without widely accepted standard of care [1,[8][9][10][11][12][13][23][24][25][26][27][28][29][30][31]. Buschke-Löwenstein tumor was initially described as a neoplasm of the penis in 1925 and later reported in the anal area [14].…”

“…There are no standard management guidelines for asymptomatic AIN and significant controversies remain as to the optimal approach [1,8,11,25,31]. Advocates for screening and surveillance of high-risk groups with anal Papanicolaou smear cytological examination, high-resolution anoscopy, and targeted destruction of asymptomatic lesions support such recommendations to prevent progression into invasive disease [1,11,12,[24][25][26]30]. At-risk groups include immunocompromised patients, men who have sex with men, or sexually promiscuous individuals.…”

“…However, regardless of where one stands on this issue, symptomatic patients with AIN require treatment. Management options include photodynamic therapy, topical ointments such as imiquimod 5% cream or 5-fluorouracil cream, infrared coagulation, argon laser ablation, cryotherapy, fulguration, local excision, and wide local excision with advancement flap or skin graft [1,8,[11][12][13][23][24][25][26][27][28][29][30]. Surgeons treating patients with AIN need to be familiar with these various options and their effectiveness as well as limitations.…”

“…And while numerous management options are available to treat such disorders, significant challenges remain in terms of disease recurrence or morbidity of treatment. Furthermore, no standardization of care exists for anal disease such as extensive carcinoma in situ or rare neoplasms such as Buschke-Löwenstein tumor [1,[4][5][6][7][8][9][10][11][12]. The purpose of this study was to review a single-center experience with wide local excision and flap or skin graft wound coverage for patients with Buschke-Löwenstein tumor or extensive circumferential anal carcinoma in situ.…”