When would you manage with wide excision and flap reconstruction and when would you apply topical FU, imiquimod photodynamic therapy, radiation or laser therapy?
This question is still without definitive answers. Various treatment modalities are studied recently but no one can be regarded as a favorite.
Please take a look at the two papers below (one systematic review and last European guidelines):
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007281.pub2/abstract;jsessionid=D73F9CC95EA2FC23146053564B27A98A.f03t04
http://onlinelibrary.wiley.com/doi/10.1111/jdv.12031/abstract
Dear Alexander
Thank you for your responce. I've got two cases with anal Bowen disease both patients were treated by wide excision and flap reconstruction. Actually, I am searching for colorectal colleagues that treated in the past similar cases to exchange experience. Both patients are symptoms free 18 months later.
Best Regards
Dear Paschalis,
Unfortunately it seems impossible to draw evidence-based recommendations for the treatment of patients with perianal/anal Bowen’s. The main reason is that there are less than 300 cases published in the literature since original paper of John Bowen, most of them being case reports. The largest series comes from Clevland Clinic and includes 47 patients treated over a period of 20 years. On the other hand those patients are treated either by dermatologists or surgeons, which additionally makes more difficult to build uniform treatment strategy I think. However I can recommend you some recent reviews on the subject:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2780245/pdf/ccrs22127.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3140334/pdf/ccrs24054.pdf
Dear Alexander
Thank you for your essential contribution to my question
i agree that their is not a good published evidence base. However from a colorectal practice point of view. Follow up up the same surgeon with regular visual inspection interspersed with mapping biopsies. If the pattern of disease changes we use appropriate local excision+/- rotational flaps. This is a very good statergy we have employed for over 20 years with a very low incidence of radicle surgical. a local referral statergy is also helpful so that someone with an actual long term intrest sees all the patients. and the same patient at each visit,
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