title: Outcomes, risk of other malignancies, and need for formal mapping procedures in patients with perianal Bowen's disease.
abstract: OBJECTIVE
  Local excision is standard treatment for Bowen's disease, but controversy exists over the incidence of synchronous and metachronous cancers as well as the role of a preexcision mapping procedure.
  
  
  METHODS
  The medical records of 25 patients treated for perianal Bowen's disease between 1978 and 2001 were retrospectively reviewed.
  
  
  RESULTS
  There were 11 men and 14 women with a mean age at diagnosis of 47.9 +/- 14.9 years. The majority of patients (72 percent) had symptom-driven biopsies. Presentation included pruritus (56 percent), mass (28 percent), bleeding (24 percent), and anal pain (4 percent). The average duration of symptoms before diagnosis was 1.3 +/- 0.5 years. Two patients had microscopic disease discovered incidentally after hemorrhoidectomy and underwent no further treatment. Twenty-three patients underwent wide local excision, of which 19 (83 percent) had a formal mapping procedure. On final pathology, 23 patients (92 percent) had clear margins. There were three recurrences (mean time to recur 2.0 +/- 1.0 years), including the two patients who had positive margins after wide excision (1 after mapping) and one patient who had clear margins after mapping. Five patients (20 percent) had other carcinomas (1 sigmoid, 4 vulvar). At follow-up, 24 patients were alive with no evidence of Bowen's disease and 1 patient was dead secondary to sigmoid cancer with no evidence of Bowen's disease.
  
  
  CONCLUSIONS
  Wide excision of perianal Bowen's disease results in excellent local control, although this is highly dependent on clear pathologic margins. A formal mapping procedure does not preclude recurrence. Initial screening and follow-up regimens are not uniform because of the wide range of treatment options available.
authors.affiliation: Division of Colorectal Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Margenthaler
authors.forename: David W
authors.initials: DW
authors.lastname: Dietz
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Mutch
authors.forename: Elisa H
authors.initials: EH
authors.lastname: Birnbaum
authors.forename: Ira J
authors.initials: IJ
authors.lastname: Kodner
authors.forename: James W
authors.initials: JW
authors.lastname: Fleshman
mesh_terms: D000328:Adult; D001004:Anus Diseases / Q000150:complications* / Q000473:pathology* / Q000601:surgery; D001706:Biopsy; D001913:Bowen's Disease / Q000150:complications* / Q000473:pathology* / Q000601:surgery; D002277:Carcinoma / Q000209:etiology; D003110:Colonic Neoplasms / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012878:Skin Neoplasms / Q000150:complications* / Q000473:pathology* / Q000601:surgery