Bowen's Disease: a four-year retrospective review of epidemiology and treatment at a university center

Abstract

Background: Cutaneous squamous cell carcinoma (SCC) in situ (Bowen's disease; BD) is a common intraepidermal malignancy. The aim of this study was to characterize the demographics, distribution, treatment, and recurrence risk of BD in a university population.

Methods: A retrospective survey of histologically confirmed BD diagnosed between January 1999 and January 2003.

Results: A total of 299 patients (193 men, 106 women) with 406 cases of BD were identified. The most common sites were the upper extremities (27%), ears (15%), and cheeks (11%). Men were significantly more likely to have SCC in situ on the scalp, ear, and anterior trunk, while the cheek, nose, and lower legs were significantly more common sites among women (p<.05). An office-based procedural treatment was performed in 92% of cases. Elliptical excision was the most common treatment modality (27%) followed by Mohs micrographic surgery (MMS; 20%) and then shave excision (19%). Histologic recurrence was seen in 15 of 406 cases (4%), one of which recurred as invasive SCC. Cryotherapy was associated with the highest recurrence rate (5-year recurrence of 13.4%), followed by topical 5-fluorouracil (9%) and shave excision (9%). Curettage and fulguration (6.5%), MMS (6.3%), and elliptical excision (5.5%) had lower 5-year recurrence rates.

Limitations: Our experience at a single institution in the midwestern United States may not be reflective of a wider population.

Conclusion: The most common locations for BD were in areas with high sun exposure. Multiple treatment options are available and recurrence is uncommon. Margin control surgery should be considered for tumors in high-risk areas.