Topical 5-fluorouracil in the management of extensive anal Bowen's disease: a preferred approach.
OBJECTIVE
An alternative approach to anal Bowen's disease was investigated. The use of topical 5 percent 5-fluorouracil for large lesions and surgical excision of small lesions were evaluated.


METHODS
A prospective study was undertaken for anal Bowen's disease in 11 patients over a six-year period. Before therapy all patients underwent anal mapping biopsy and colonoscopy. For one-half circumferential disease or greater, patients underwent topical 5 percent 5-fluorouacil therapy for 16 weeks. For smaller involvement, wide surgical excision was performed. All patients underwent anal mapping biopsy one year after completion of therapy.


RESULTS
Of 11 patients, 8 (5 male) received 16 weeks of topical 5 percent 5-fluorouacil therapy. Three patients (3 female) underwent surgical excision for localized disease. All but one patient, who was HIV positive, were free of Bowen's disease one year after completion of therapy. One patient underwent total excision of a residual microinvasive squamous carcinoma after circumferential Bowen's disease had resolved. One patient received eight additional weeks of topical 5-fluorouacil therapy for incomplete resolution. All patients were followed yearly, with a mean follow-up of 39 months and a range of 12 to 74 months. There have been no recurrences. There were no long-term side effects or morbidity from topical 5-fluorouacil or local excision. All colonoscopies were normal.


CONCLUSIONS
Topical 5 percent 5-fluorouacil therapy is a safe and effective method to treat anal Bowen's disease. Wide local excision is appropriate for smaller, isolated areas of disease. Anal Bowen's disease was not associated with colonic or other neoplasms.
Graham
Bruce D
BD
Department of Colon and Rectal Surgery, Shawnee Mission Medical Center, Shawnee Mission, Kansas, USA.
Jetmore
Allen B
AB
Foote
Jerry E
JE
Arnold
L Kirk
LK
D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D001005:Anus Neoplasms / Q000188:drug therapy* / Q000473:pathology; D001706:Biopsy; D001913:Bowen's Disease / Q000188:drug therapy* / Q000473:pathology; D003113:Colonoscopy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome
D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil