Abstract
Management of BD is widely variable and there is little evidence for the most appropriate treatment. Our aim was to evaluate the effectiveness of ingenol mebutate (IM) gel in the treatment of patients with Bowen’s disease (BD). We performed a retrospective analysis of 24 cases of biopsy-confirmed BD treated with IM. Data retrieved from the patients’ file included age, sex, anatomic sites, clinical images of lesions, histopathological data of skin biopsies, local skin reactions, clinical and histological response to treatment, alternative treatments tried and follow-up. The majority of patients were females (18/24, 75%), with an average age of 79.5 years (range 53-90 years). Four of the 24 patients were lost to follow-up. The average duration of follow-up was 10.4 months (range 0.5-44 months). After treatment with IM, 41.7% of patients showed complete clinical resolution. Retreatment with IM of six non-responder patients led to three more cases of successful healing. Therefore, 54.2% of patients with BD lesions achieved complete resolution after treatment with one or two cycles of IM. Local skin reactions were mostly mild or moderate, and only 12.5% were regarded as severe. The results indicate that topical IM gel may be considered as a safe and beneficial non-invasive treatment option for BD, especially in patients who are poor candidates for surgery and anatomical sites that are unsuitable for other treatments. The acceptable safety profile, short treating course and easy self-application of IM gel may improve patient compliance.
Highlights
Bowen’s disease (BD) is a form of in situ squamous cell carcinoma, which may develop to invasive skin malignancy in 3 to 5% of cases if left untreated [1, 2]
In the present study we aimed to report the results of a retrospective study of 24 patients with BD treated with ingenol mebutate (IM) gel
Patients who experienced non-complete resolution (NCR) of lesions were subsequently treated with IM under the same regimen as outlined previously, topical 5% imiquimod, topical photodynamic therapy (PDT) with methyl aminolevulinate (MAL-PDT) (2 sessions separated by a oneweek interval), or excisional surgery, depending on the physician’s criteria
Summary
Bowen’s disease (BD) is a form of in situ squamous cell carcinoma, which may develop to invasive skin malignancy in 3 to 5% of cases if left untreated [1, 2]. Etiological factors of BD include irradiation -mainly ultraviolet radiation-, carcinogens, immunosuppression, viral and some others like chronic injury or dermatoses, being long-term sun exposure the strongest risk factor for the development of the disease [3, 4]. BD affects predominantly older individuals, with a higher risk of comorbidities, and is frequently located on body sites with poor wound healing. There are multiple treatment options for BD and many variables that may influence the choice of treatment in an individual, including age and immunological status of the patient, number and size of lesions, and sites affected [5]. There is no single modality that can be regarded as optimum for BD management, a non-invasive procedure is often the most convenient therapeutic approach. Nonsurgical treatments such as topical therapies (i.e., 5-fluorouracil and imiquimod) and photodynamic therapy (PDT), cryotherapy and radiotherapy, among others, are viable alternatives to surgical excision [4]
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