Among practice-related interventions for cutaneous squamous cell carcinoma (SCC) in situ, also known as Bowen’s disease, surgery demonstrated superior efficacy over alternative treatment pathways, according to
Background and Methods
Cutaneous SCC lesions tend to remain persistent in nature, and approximately 3% may progress to invasive SCC, potentially leading to a more aggressive form of the disease. While surgical excision is considered the most common method of treatment, other treatments such as radiation therapy, chemotherapy, CO2 laser, and dermabrasion, among others, are on the landscape.2
Citing limited research comparing these modalities, the researchers conducted a systematic review by searching multiple databases and independently examining studies for relevance. They extracted data for various treatment effects and used a generalized linear mixed model to perform a meta-analysis of random-effects ratios, accounting for within-study uncertainties. They assessed study quality using NHLBI tools and used the I² statistic to measure heterogeneity.
Findings
The initial search identified 3,375 references, which were narrowed down to 71 relevant studies after screening. These included 39 before-and-after studies, 18 controlled intervention studies and 14 observational cohort studies. After quality assessment, the researchers rated 20 studies as good, 42 as fair and 9 as poor.
The researchers evaluated the lesion clearance rate (LCR) in different methods. The pooled LCR for high-quality studies was 78%, with surgery and a combination of CO2 laser, dermabrasion, and 5-fluorouracil showing the highest clearance rates of 97%. Overall, treatment options including surgery, CO2 laser + dermabrasion + 5-fluorouracil, and various photodynamic therapies (PDT) demonstrated superior efficacy compared to placebo.
The researchers also assessed participant clearance rate (PCR), indicating the percentage of patients with complete resolution of all lesions. Pooled PCR for high-quality studies was 72%. Surgery and combination therapy with CO2 laser + dermabrasion + 5-fluorouracil again demonstrated the highest participant clearance rates, approaching 97%.
In an assessment of the lesion recurrence rate (LRR), the researchers found a pooled LRR of 13% for high-quality studies. CO2 laser + dermabrasion + 5-fluorouracil and laser + methyl aminolevulinate PDT showed the lowest recurrence rates, at 4% and 7%, respectively.
Participant recurrence rate (PRR), which reflects the likelihood that patients will develop new or recurrent lesions, was assessed for a smaller subset of studies. Aminolevulinic acid PDT emerged as the most effective treatment, achieving a PRR of 0%. In comparison, surgical treatments showed a significantly lower PRR compared to cryotherapy.
conclusions
“Our results suggest that surgery may be the most effective treatment option for patients with Bowen’s disease compared to other available treatment options,” according to Petzold et al.
However, the review authors noted that clear differences in effectiveness between non-surgical interventions could not be demonstrated due to limited data. They also called for additional high-quality trials to further compare non-surgical treatment modalities.
“Clinicians should carefully consider individual needs, patient characteristics, lesion locations, patient preferences, and any comorbidities when selecting appropriate treatment,” they wrote.
References
- Petzold A, Wessely A, Steeb T, Berking C, Heppt MV. Effectiveness of interventions for cutaneous squamous cell carcinoma in situ (Bowen’s disease): a systematic review and meta-analysis of proportions. J Eur Acad Dermatol Venereol. August 16, 2024.
https://doi.org/10.1111/jdv.20267 - Arlette JP, Trotter MJ. Squamous cell carcinoma in situ of the skin: history, presentation, biology, and treatment. Australas J Dermatol. 2004? 45(1): 1–11.
