Background: While the standard treatments for Bowen's disease (BD) (surgery, cryotherapy and antimitotic agents) are efficient, they are associated with extensive scarring. In this paper we confirm that photodynamic therapy using topical aminolevulinic acid provides effective treatment for this disease.
Patients and methods: Twenty-two patients with a total of 38 cases of BD were included in this retrospective single-centre study between 2001 and 2006. They were treated with photodynamic therapy using topical aminolevulinic acid (Metvix. The study criteria consisted of patient age and gender, site and area of lesions, number of patients with multiple patches of BD and/or large lesions, tolerance of the treatment, clinical response and quality of wound healing at 3, 6 and 12 months. Annual follow-up was conducted for five years. The probability of remission up to 60 months after treatment was determined by means of survival analysis based on the variable-interval actuarial method.
Results: Seven men and 15 women of median age: 76 years (interquartile range: [69-82]) with 38 cases of Bowen's diseases were treated with photodynamic therapy. In terms of frequency, lesions were seen predominantly on the lower limbs (N=24) and face (N=10). Other lesions were seen on the trunk or back (N=4). The mean surface area of lesions was 8.62 cm2 (1-96 cm2). Eight patients were presenting multiple patches of BD (> or = three lesions), and large lesions were noted in 11 cases. The most common adverse effect was an immediate burning sensation, described by 32% of patients (n=7). Treatment was effective, with remission being achieved in all patients at 3 months of follow-up. Wound healing was optimal and without atrophy or cosmetic sequelae. The remission rate was 100% at 6 months, 95% at 12 months and 85% at 24 months.
Discussion: This open retrospective study confirmed the good efficacy of photodynamic therapy in the treatment of BD in terms of both clinical remission and cosmetic results. It enables easier treatment of large and/or multiple lesions than surgery. It is more suitable for elderly patients than either topical anticancer drugs, which require prolonged compliance, or surgery and cryotherapy, both of which result in slow-healing postoperative wounds.
Conclusion: Since photodynamic therapy is a very costly therapeutic method, we feel that dynamic phototherapy should be used only for large and/or multifocal lesions or for lesions of the lower limbs in patients with chronic venous insufficiency.