Interventions for cutaneous Bowen's disease

Abstract

Overall, there has been very little good-quality research on treatments for Bowen's disease. There is limited evidence from single studies to suggest MAL-PDT is an effective treatment. Although cosmetic outcomes appear favourable with PDT, five-year follow-up data are needed. Significantly more lesions cleared with MAL-PDT compared to cryotherapy. No significant difference in clearance was seen when MAL-PDT was compared with 5-FU, but one study found a significant difference in clearance in favour of ALA-PDT when compared to 5-FU. There was no significant difference in clearance when cryotherapy was compared to 5-FU.The lack of quality data for surgery and topical cream therapies has limited the scope of this review to one largely about PDT studies. The age group, number, and size of lesions and site(s) affected may all influence therapeutic choice; however, there was not enough evidence available to provide guidance on this. More studies are required in the immunosuppressed populations as different therapeutic options may be preferable. Specific recommendations cannot be made from the data in this review, so we cannot give firm conclusions about the comparative effectiveness of treatments.

Current evidence and applications of photodynamic therapy in dermatology

“…PDT demonstrated superior efficacy and less scarring in the treatment of SCC in situ when compared with cryotherapy or 5-fluorouracil in a Cochrane review (n=363) 63. In particular, ALA-PDT appeared to have greater efficacy than 5-fluorouracil but MAL-PDT was not demonstrated to be superior over 5-fluorouracil.…”

Photodynamic Therapy in Bowen's Disease: Influence of Histological Features and Clinical Characteristics on Its Success

“…There is no consensus on the most effective treatment due to lack of controlled trials [4,8]. The British guidelines state that no treatment modality is superior to others and that choosing a therapeutic option for a patient is dependent on localisation of the tumour, expected efficacy, patient basal status, infrastructural and economic resources and patient preferences [4,7].…”

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

“…There are many treatment modalities available including surgical excision, Mohs surgery, curettage, cryotherapy, photodynamic therapy, topical 5-fluorouracil and topical imiquimod. (13) There are rare case reports of selfresolving Bowen's Disease. (14) Surgical modality has been the most commonly used modality in both UK and Australia.…”

“…(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.…”