BOWEN'S BLOWN AWAY! - SUCCESSFUL MANAGEMENT OF BOWEN'S DISEASE BY TOPICAL 5% 5-FU AND CRYOTHERAPY

Abstract

BACKGROUND: Bowen disease (BD) is a rare, persistent, and progressive form of in situ Squamous Cell Carcinoma characterized by a solitary red, scaly or crusted plaque with potential for malignant change around 8%. Persistent growth usually occurs but partial regressions are not uncommon. Several modalities of treatment are available which show varying results. In our Case Report, we present a 74-year-old male who was diagnosed with Bowen's Disease clinico-pathologically and was treated with cyclical topical 5% 5-FU cream and Cryotherapy using Liquid Nitrogen. CASE DESCRIPTION: A 74-year-old male came to our OPD with complaints of a single, persistent, asymptomatic psoriasiform plaque of size measuring 4x4 cm over his abdomen for 3 years. The plaque was progressively enlarging and showed resistance to topical therapies with salicylic acid, potent topical steroids, and emollients for the past 3 years. A clinical diagnosis of Bowen's Disease was made, and biopsy was done. Histopathological Examination revealed intra-epidermal dysplasia with characteristic 'wind-blown' appearance of keratinocytes in the epidermis. Atypical mitotic gures were seen. Dense lymphocytic inltrate with pigment laden macrophages were seen at DEJ. Patient was started on topical 5% 5-Fluorouracil (5-FU) cream which he applied three nights a week along with Cryotherapy using Liquid Nitrogen (8 sessions of cryotherapy with two 5-10 secs Freeze-Thaw cycles were done at 3 weekly intervals). Biopsy taken at end of 6 months showed a normal epidermis with no evidence of in situ changes. Next evaluation will be after 3 months. CONCLUSION: There are multiple treatment modalities available for BD with no option superior to other. 5% 5-FU is showing increasing effectiveness (up to 96.2%) especially when combined with other treatment options such as cryotherapy which on its own showed great clearance rates (greater than 90%) depending on the duration of freeze-thaw cycles. Main advantage of this combination is its ease of application, low cost and non-invasiveness.