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Perianal Bowen's disease

Associated tumors, human papillomavirus, surgery, and other controversies

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

Abstract

BACKGROUND: Perianal Bowen's disease (BD) is an intraepithelial nonkeratinizing carcinoma, associated historically with internal tumors. METHODS: A review of patients with perianal BD presenting consecutively during a 25-year span was undertaken, excluding Bowenoid papulosis and contiguous genital BD. Histologic slides were resubmitted for review by an experienced pathologist, in a “blind” fashion among other slides. Follow-up was updated in every patient. Survival and recurrence curves were generated by the Kaplan-Meier method and were compared with a normal age-matched population (log-rank test). RESULTS: Nineteen patients were identified; 15 of them were females. Mean age±standard deviation was 49.6±10.6 years. Five patients had a coincidental diagnosis (hemorrhoidectomy or wart excision). No associated carcinomas were found; however, eight patients had isolated BD of the vulva. Eleven patients had a history of anal warts, cervical/vulvar dysplasia, or both. Wide resection, including V-Y flaps, was performed in 18 patients without dysfunction. One-year and five-year recurrence was 16 and 31 percent. Recurrence was treated in all but one case by wider resection. Mean follow-up was 8.4 years. Five-year survival was 75 percent, lower than the matched population (P=0.001); however, only one death was related to BD. CONCLUSIONS: Perianal BD has no association with internal tumors. Despite a high rate of recurrence, perianal BD can be treated by local excision. An increased rate of human papilloma virus-related entities was found, which could suggest a causative role.

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Authors and Affiliations

  1. Divisions of Colon & Rectal Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota

    Juan M. Sarmiento M.D., Bruce G. Wolff M.D. & Francis A. Frizelle M.D.

  2. Divisions of Pathology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota

    Lawrence J. Burgart M.D.

  3. Divisions of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota

    Duane M. Ilstrup M.S.

Authors
  1. Juan M. Sarmiento M.D.
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  2. Bruce G. Wolff M.D.
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  3. Lawrence J. Burgart M.D.
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  4. Francis A. Frizelle M.D.
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  5. Duane M. Ilstrup M.S.
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Sarmiento, J.M., Wolff, B.G., Burgart, L.J. et al. Perianal Bowen's disease. Dis Colon Rectum 40, 912–918 (1997). https://doi.org/10.1007/BF02051198

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