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

Background In our departments, curettage and cautery (C&C) and liquid nitro gen 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 w ith a conventional disposable curette under local anaesthesia, and electroc autery was then used for haemostasis. Results Eighty lesions in 67 patients (55 female) were analysed. The mean a ge of the patients was 74 years (range 46-89). The most frequent site was t he lower leg, below the knee (n = 59, 74%). The average time taken for comp lete 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 le sions), 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 an tibiotics developed in four patients. Thirteen of the treated lesions had r ecurred 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 occur red 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 hea l (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 th e treatment of BD, especially for lesions on the lower leg. Curettage of le sions of BD is associated with a significantly shorter healing time, less p ain, fewer complications and a lower recurrence rate when compared with cry otherapy.