title: Comparison of cryotherapy with curettage in the treatment of Bowen's disease: a prospective study.
abstract: BACKGROUND
  In our departments, curettage and cautery (C&C) and liquid nitrogen cryotherapy are the preferred methods of treatment for Bowen's disease (BD).
  
  
  OBJECTIVE
  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.
authors.affiliation: Department of Dermatology, Walsgrave Hospital NHS Trust, Coventry CV2 2DX, UK.
authors.forename: I
authors.initials: I
authors.lastname: Ahmed
authors.forename: J
authors.initials: J
authors.lastname: Berth-Jones
authors.forename: S
authors.initials: S
authors.lastname: Charles-Holmes
authors.forename: C J
authors.initials: CJ
authors.lastname: O'Callaghan
authors.forename: A
authors.initials: A
authors.lastname: Ilchyshyn
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001913:Bowen's Disease / Q000473:pathology / Q000601:surgery*; D003452:Cryosurgery / Q000379:methods*; D003475:Curettage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010149:Postoperative Pain; D011446:Prospective Studies; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome