Surgical excision in Bowen’s disease

Background: Bowen’s disease is a form of intraepidermal squamous cell carcinoma (SCC) characterised by a persistent, non-elevated, red, scaly or crusted plaque with a small potential for invasive malignancy. Most cases of typical Bowen’s disease in the white population are found on the lower legs of the elderly women. However, in this part of the world, i.e. Kashmir, the most common site is thighs followed by the lower abdomen. A range of treatment options are available for it including cryotherapy, curettage and cautery, photodynamic therapy, laser destruction, surgical excision, 5-fluorouracil cream, imiquimod cream, and radiotherapy. The aim of this study was to evaluate the efficacy of surgical excision in Bowen’s disease. Method: All the patients with biopsy proven Bowen’s disease were included for the study. A detailed history was taken for each patient including the history of medical treatment for Bowen’s disease. Wide surgical excision (including either fusiform excision, W-plasty, or Z-plasty) was performed in each patient and the patients were then followed up for any recurrence. No sign of renewed disease activity at 6 months follow-up was taken as cure. All patients are intended to be followed up for 5 years. Result: Ten out of 12 patients reported the use of topical imiquimod cream but complained of the progression of lesions. Surgical excision was performed in 12 patients. All the patients are currently under regular follow-up. Except for secondary infection and wound dehiscence in one patient, all the patients are in good condition with no signs of recurrence. Conclusion: Although it was a preliminary study, we recommend surgical excision in treatment of Bowen’s disease due to low recurrence rate.