Choosing an optimal treatment for Bowen’s disease requires balancing lesion clearance, treatment burden, cosmetic outcomes, and patient preferences. A large randomized trial–based analysis published in Dermatology provides practical evidence to support topical 5-fluorouracil (5-FU) as a first-line option for appropriately selected patients, particularly when minimizing procedural burden is a priority.
The analysis was conducted alongside a multicenter randomized controlled noninferiority trial involving 250 patients with histologically confirmed Bowen’s disease. Patients were assigned to surgical excision, methyl aminolevulinate photodynamic therapy, or topical 5% 5-fluorouracil cream. While the primary focus of the study was cost comparison within a European health system, the clinical findings have clear relevance for treatment selection in routine dermatology practice.
At 12 months, surgical excision achieved the highest rate of sustained lesion clearance. However, topical 5-FU remained within the predefined noninferiority margin established in the parent trial. In practical terms, this means that while recurrence was modestly more frequent with topical therapy, effectiveness remained acceptable for many patients – particularly given the ease of retreatment.
Treatment burden differed substantially among options. Surgical excision and photodynamic therapy required hospital-based visits, procedural time, and postprocedure follow-up. In contrast, topical 5-FU was self-administered, avoided procedural recovery, and required fewer in-office visits. These differences translate into lower overall treatment intensity, and may be especially relevant for older patients, those with multiple lesions, or individuals prioritizing convenience and cosmetic outcomes.
Although the study’s cost findings are based on European health care structures and are not directly transferable to the US setting, the relative differences in treatment burden remain clinically meaningful. The authors emphasized that recurrences following topical therapy were generally manageable and did not compromise long-term outcomes when appropriately addressed.
For US dermatologists, these findings support topical 5-FU as a reasonable first-line option for Bowen’s disease in carefully selected patients – particularly when prioritizing noninvasive management, reduced procedural burden, and patient-centered care. Surgical excision remains appropriate for lesions requiring definitive clearance, while photodynamic therapy may be reserved for specific clinical scenarios.
Source: Dermatology
