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Interventions for cutaneous Bowen's disease


Bath-Hextall, F.J., et al

Subject Keywords: Therapeutic interventions, Cutaneous Bowen's disease, Skin cancer
Set: Cancer
Chronic Conditions
Type: Article
Region: International (other)

Bowen's disease is the clinical term for a particular precancerous skin lesion. These lesions rarely cause patients any symptoms, but appear as well-defined scaly patches on sun-exposed skin, commonly in those over 60 years. They occur more in women and most frequently involve the lower legs of those affected in the UK. It is not known why, but the body sites most commonly affected vary across different countries. In general, people with Bowen's disease have an excellent prognosis because the disease is typically slow to develop and responds favourably to treatment. Lesions are usually slow-growing, and although they are not life-threatening, there is a small risk of progression to a skin cancer (estimated to be 3%) known as invasive squamous cell carcinoma.

This review attempted to find which is the most effective treatment for cutaneous Bowen's disease, with the least side-effects.

There are a range of treatment options including the following: topical therapies, such as 5-fluorouracil (5-FU) and imiquimod creams; surgical interventions, such as excision and Mohs micrographic surgery; destructive therapies, such as cryotherapy (freezing); and light-based therapies, such as photodynamic therapy (where a light-sensitive cream is used in combination with visible light).

We included 9 randomised controlled trials, with a total of 363 participants. No studies examined surgical methods.

Photodynamic therapy appears to be an effective treatment and has the benefit of minimal scarring compared with cryotherapy or 5-fluorouracil. Cryotherapy is convenient and less expensive, but does not appear to be as effective as photodynamic therapy and results in more scarring; 5-aminolevulinic acid with photodynamic therapy (ALA-PDT) appears to be more effective than 5-fluorouracil, whereas methyl aminolevulinate with photodynamic therapy (MAL-PDT) does not appear to be as good as 5-fluorouracil. One study demonstrated benefit with imiquimod cream.

Specific recommendations cannot be made from these data, so this review cannot give firm conclusions about the comparative effectiveness of treatments. There is a clear need for future research to focus on a range of different studies comparing various therapies with each other, and in particular to surgical treatments to provide high-quality evidence to guide clinical practice. The age group, number and size of lesions, sites affected, and immunological status may all influence therapeutic choices. Longer-term follow up (up to 10 years) is needed to determine the effect of treatments on risk of progression of lesions of Bowen's disease to squamous cell carcinoma.



Rights: © The Cochrane Collaboration
Suggested citation:

Bath-Hextall, F.J., et al. (2013) Interventions for cutaneous Bowen's disease [Online]. Available from: [Accessed: 21st May 2018].


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