From the Guidelines
Treatment of Bowen's disease in the groin should prioritize photodynamic therapy (PDT) due to its effectiveness, good cosmesis, and fewer adverse events compared to other modalities, as supported by the British Association of Dermatologists' guidelines 1.
Treatment Options
- Topical therapies: 5-fluorouracil (5-FU) cream applied twice daily for 4-8 weeks, or imiquimod 5% cream applied 3-5 times weekly for 6-16 weeks
- Surgical procedures: excision with 4-6mm margins for smaller lesions
- Non-surgical destructive methods: cryotherapy using liquid nitrogen, curettage and electrodesiccation
Considerations for Groin Location
- Skin sensitivity and potential for irritation require special consideration
- Regular follow-up is essential due to recurrence rates ranging from 5-20% depending on the treatment method
- Monitoring for progression to invasive squamous cell carcinoma, which occurs in approximately 3-5% of untreated cases, is crucial
Evidence-Based Recommendation
The British Association of Dermatologists' guidelines 1 suggest that PDT is a preferred treatment option for Bowen's disease, especially for large or multiple lesions, due to its effectiveness and good cosmesis. A study published in the British Journal of Dermatology 1 also supports the use of PDT for Bowen's disease, demonstrating its efficacy and safety. Therefore, PDT should be considered as a first-line treatment for Bowen's disease in the groin, taking into account the patient's individual needs and lesion characteristics.
From the Research
Treatment Options for Bowen's Disease in the Groin
- The treatment of Bowen's disease depends on various factors, including the site, size, immune status, patient's age, and esthetic outcome 2.
- Available therapeutic modalities for Bowen's disease include:
- Topical chemotherapy
- Surgical modalities
- Light-based modalities
- Destructive therapies
Specific Treatment Options
- Topical imiquimod 5% cream has been successfully used to treat Bowen's disease, with a complete clinicopathologic regression rate of 80% in one study 3.
- Surgical excision is considered the gold standard treatment, with a high clearance rate and low recurrence rate 4.
- Cryotherapy, photodynamic therapy, and topical 5-fluorouracil are also treatment options, but may have higher recurrence rates or longer treatment periods 4, 5.
- Topical imiquimod 5% cream has been used to treat Bowen's disease in sensitive areas, such as the penis, with successful results 6.
Considerations for Treatment
- The choice of treatment should take into account the patient's overall health, age, and immune status 2.
- Careful monitoring is required when performing cryotherapy for treatment of Bowen's disease, due to the risk of satellite lesions 4.
- Non-invasive or non-destructive treatment options may be preferred for patients with poor wound healing or comorbidities 5.