Surgery Exhibits Superior Efficacy for Cutaneous Squamous Cell Carcinoma In Situ

Among practice-related interventions for cutaneous squamous cell carcinoma (SCC) in situ, also known as Bowen's disease, surgery exhibited superior efficacy versus alternative treatment routes, according to a review published in the Journal of the European Academy of Dermatology and Venereology.¹

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Background and Methods

Cutaneous SCC lesions tend to remain persistent in nature, and approximately 3% may advance to invasive SCC, potentially leading to a more aggressive form of the disease. While surgical excision is considered the most common modality for treatment, other therapies, such as radiation therapy, chemotherapy, CO2 laser, and dermabrasion, among others, exist in the landscape.²

Citing limited research comparing these modalities, researchers performed a systematic review by searching multiple databases and independently screening studies for relevance. They extracted data on various treatment outcomes and used a generalized linear mixed model to conduct a random-effects meta-analysis of proportions, accounting for within-study uncertainties. They assessed study quality utilizing NHLBI tools, and used the I² statistic to measure heterogeneity.

Findings

The initial search identified 3,375 references, which were narrowed down to 71 relevant studies after screening. These included 39 before-after studies, 18 controlled intervention studies, and 14 observational cohort studies. After an evaluation of quality, researchers rated 20 studies as good, 42 as fair, and 9 as poor.

Researchers assessed lesion clearance rate (LCR) across different modalities. The pooled LCR for high-quality studies was 78%, with surgery and a combination of CO2 laser, dermabrasion, and 5-fluorouracil showing the highest clearance rates of 97%. Overall, treatment options including surgery, CO2 laser + dermabrasion + 5-fluorouracil, and various photodynamic therapies (PDT) exhibited superior efficacy compared to placebo.

Researchers also assessed participant clearance rate (PCR), indicating the percentage of patients with complete resolution of all lesions. The pooled PCR for high-quality studies was 72%. Surgery and the CO2 laser + dermabrasion + 5-fluorouracil combination therapy again demonstrated the highest participant clearance rates, approaching 97%.

In an assessment of lesion recurrence rate (LRR), researchers identified a pooled LRR of 13% for high-quality studies. CO2 laser + dermabrasion + 5-fluorouracil and laser + methyl aminolevulinate PDT demonstrated the lowest recurrence rates, at 4% and 7%, respectively.

Participant recurrence rate (PRR), reflecting the likelihood of patients experiencing new or recurrent lesions, was evaluated for a smaller subset of studies. Aminolevulinic acid PDT emerged as the most effective treatment, achieving a PRR of 0%. Comparatively, surgical treatments showed a significantly lower PRR compared to cryotherapy.

Conclusions

"Our results indicate that surgery might be the most effective treatment option for patients with Bowen's disease compared to other available treatment options," according to Petzold et al.

However, review authors noted that it was not possible to demonstrate clear differences in efficacy between non-surgical interventions due to limited data. They also called for additional high-quality trials to further compare non-surgical treatment modalities.

"Clinicians need to carefully consider the needs of individuals, patient characteristics, sites of the lesions, patient preferences and any comorbidities when choosing an appropriate treatment," they wrote.

References

1. Petzold A, Wessely A, Steeb T, Berking C, Heppt MV. Efficacy of interventions for cutaneous squamous cell carcinoma in situ (Bowen's disease): a systematic review and meta-analysis of proportions. J Eur Acad Dermatol Venereol. August 16, 2024. https://doi.org/10.1111/jdv.20267
2. Arlette JP, Trotter MJ. Squamous cell carcinoma in situ of the skin: history, presentation, biology and treatment. Australas J Dermatol. 2004; 45(1): 1–11.