Perianal Bowen's disease: associated tumors, human papillomavirus, surgery, and other controversies.
BACKGROUND
Perianal Bowen's disease (BD) is an intraepithelial nonkeratinizing carcinoma, associated historically with internal tumors.


METHODS
A review of patients with perianal BD presenting consecutively during a 25-year span was undertaken, excluding Bowenoid papulosis and contiguous genital BD. Histologic slides were resubmitted for review by an experienced pathologist, in a "blind" fashion among other slides. Follow-up was updated in every patient. Survival and recurrence curves were generated by the Kaplan-Meier method and were compared with a normal age-matched population (log-rank test).


RESULTS
Nineteen patients were identified; 15 of them were females. Mean age +/- standard deviation was 49.6 +/- 10.6 years. Five patients had a coincidental diagnosis (hemorrhoidectomy or wart excision). No associated carcinomas were found; however, eight patients had isolated BD of the vulva. Eleven patients had a history of anal warts, cervical/vulvar dysplasia, or both. Wide resection, including V-Y flaps, was performed in 18 patients without dysfunction. One-year and five-year recurrence was 16 and 31 percent. Recurrence was treated in all but one case by wider resection. Mean follow-up was 8.4 years. Five-year survival was 75 percent, lower than the matched population (P = 0.001); however, only one death was related to BD.


CONCLUSIONS
Perianal BD has no association with internal tumors. Despite a high rate of recurrence, perianal BD can be treated by local excision. An increased rate of human papilloma virus-related entities was found, which could suggest a causative role.
Sarmiento
J M
JM
Division of Colon & Rectal Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
Wolff
B G
BG
Burgart
L J
LJ
Frizelle
F A
FA
Ilstrup
D M
DM
D001004:Anus Diseases / Q000150:complications; D001005:Anus Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery; D001913:Bowen's Disease / Q000150:complications* / Q000473:pathology / Q000601:surgery; D005260:Female; D006484:Hemorrhoids / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000150:complications*; D012307:Risk Factors; D014412:Tumor Virus Infections / Q000150:complications*; D014860:Warts / Q000150:complications