Bowen’s disease is a type of squamous cell carcinoma (SCC) in situ of the skin usually characterized by slow-growing, red and scaly patches of skin. Bowen’s disease can be symptomatic and can progress to invasive SCC causing morbidity and even mortality.
In their paper “Radiation therapy with superficial X-rays results in long-term control and less epilation than megavoltage electron therapy for forehead Bowen’s disease” Gerald B Fogarty, Amy Ziebell, Stephanie Nicholls, Arthur Martin and Karen Stapleton present a case of worsening Bowen’s disease in a functionally and cosmetically sensitive area for treatment with an Xstrahl 200 radiotherapy system.
Successive treatments with cryotherapy, photodynamic therapy and a ten-week course of bi-daily local application of 5% fluorouracil cream failed, and two plastic surgeons declined to operate. The patient benefitted in terms of quality of life and oncological outcomes from mapping with reflectance confocal microscopy.
The dosimetric advantages of radiation therapy using superficial X-rays over megavoltage electron therapy gave less epilation during treatment. Maintaining hair was important as the patient had a public profile and the hair provided a long fringe that covered the area of Bowen’s disease. The superficial X-ray machine used also facilitated set up. Three years after treatment, there was no sign of disease, nor of any hair loss and cosmesis was excellent.