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.