Comparison of cryotherapy with curettage in the treatment of Bowen's disease: a prospective study.

Abstract

BACKGROUND:

In our departments, curettage and cautery (C&C) and liquid nitrogen cryotherapy are the preferred methods of treatment for Bowen's disease (BD).

OBJECTIVES:

We aimed to compare these two treatments with regard to efficacy, time to heal, morbidity and recurrence rate.

METHODS:

Cryotherapy was performed using a liquid nitrogen spray giving two freeze-thaw cycles, each freeze cycle being maintained for 5-10 s after the formation of an ice ball to the intended margin. Curettage was performed with a conventional disposable curette under local anaesthesia, and electrocautery was then used for haemostasis.

RESULTS:

Eighty lesions in 67 patients (55 female) were analysed. The mean age of the patients was 74 years (range 46-89). The most frequent site was the lower leg, below the knee (n = 59, 74%). The average time taken for complete healing after the procedure was 60 days. The mean size of the lesions was 336 mm(2) (range 30-1890). The patients were followed up for a mean of 22 months (range 6-24, median 2 years). In the cryotherapy group (n = 36 lesions), the median time to complete healing was 46 days (range 14-210; mean 69). Twelve lesions took more than 90 days to heal. Infection requiring antibiotics developed in four patients. Thirteen of the treated lesions had recurred by 24 months. In the C&C group (n = 44 lesions), the median time to healing was 35 days (range 14-330; mean 53). Six of the lesions took more than 90 days to heal. Infection developed in two patients. Recurrence occurred in four lesions over the follow-up period. Considering BD on the lower legs separately, lesions took on average 90 days to heal in the cryotherapy group (n = 23), whereas in the C&C group (n = 36) they took 39 days to heal (P < 0.001). During the procedure and the subsequent 24 h, patients were 10.4 times more likely to report pain of any degree for lesions treated by cryotherapy than by C&C (P < 0.001).

CONCLUSIONS:

This study suggests a superiority of C&C over cryotherapy in the treatment of BD, especially for lesions on the lower leg. Curettage of lesions of BD is associated with a significantly shorter healing time, less pain, fewer complications and a lower recurrence rate when compared with cryotherapy.

• Authors: I Ahmed, J Berth-Jones, S Charles-Holmes, C J O'Callaghan, A Ilchyshyn
• Journal: The British journal of dermatology (Br J Dermatol) Vol. 143 Issue 4 Pg. 759-66 (Oct 2000) ISSN: 0007-0963 [Print] England
• PMID: 11069453 (Publication Type: Clinical Trial, Comparative Study, Controlled Clinical Trial, Journal Article, Multicenter Study)

Topics

• Aged
• Aged, 80 and over
• Bowen's Disease (pathology, surgery)
• Cryosurgery (methods)
• Curettage
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Neoplasm Recurrence, Local
• Pain, Postoperative
• Prospective Studies
• Skin Neoplasms (pathology, surgery)
• Time Factors
• Treatment Outcome