Bowen's disease of the distal digit: Outcome of treatment with carbon dioxide laser vaporization

BACKGROUND. Bowen's disease (squamous cell carcinoma in situ) is an intraepithelial neoplasm that can transform into invasive squamous cell carcinoma. The preferred method of eradication for Bowen's disease is surgical excision. However, when Bowen's disease occurs on the digit, surgical removal can lead to scar contracture and loss of use of the finger. OBJECTIVE. To assess the utility of carbon dioxide (CO₂) laser vaporization in eradicating Bowen's disease of the finger while maintaining the full range of motion and use of the digit. METHODS. Five patients were treated with CO₂ laser vaporization for Bowen's disease of the digit. Patients were followed postoperatively for recurrence, clinical appearance, especially for scar formation, and function of the involved joints over a 6-month to 3-year period. RESULTS. Four of five patients had no recurrence. Healing resulted in only modest alterations in the cosmetic appearance in comparison with the surrounding untreated skin. Posttreatment biopsy showed slight thinning of the epidermis and mild fibroplagia limited to the papillary dermis. Patients reported only mild postprocedure discomfort and no patients had any loss of function of the digit. CONCLUSIONS. CO₂ laser vaporization may be a safe and effective means by which to eradicate Bowen's disease of the finger without the risk of scar contracture and loss of function of the digit.