Outcome after surgical resection for high-grade anal intraepithelial neoplasia (Bowen's disease)

Br J Surg. 1999 Aug;86(8):1063-6. doi: 10.1046/j.1365-2168.1999.01184.x.


Background: High-grade anal intraepithelial neoplasia (Bowen's disease) may predispose to anal carcinoma. Treatment options include surgical resection but effectiveness remains uncertain. This paper reports long-term follow-up of patients with high-grade anal intraepithelial neoplasia treated by surgical resection.

Methods: Between 1989 and 1996, 46 patients were identified with high-grade anal intraepithelial neoplasia. Thirty-four underwent local excision of all macroscopically abnormal disease and the resulting defect was left open, closed primarily or skin grafted. Regular follow-up subsequently included anoscopy and biopsy of any suspicious lesions.

Results: Median follow-up was 41 (range 12-104) months. Total excision was difficult; 19 patients had histological evidence of incomplete excision at the time of initial resection. Some 12 of 19 had histo-logically proven recurrent high-grade intraepithelial neoplasia within 1 year. Even with microscopically complete excision two of 15 patients subsequently developed recurrent high-grade intraepithelial neoplasia at 6 and 32 months after operation. No patient developed carcinoma but five had complica-tions of anal stenosis or faecal incontinence.

Conclusion: Although no definite recommendations can be made for the treatment of high-grade anal intraepithelial neoplasia, these results illustrate some potential drawbacks of surgical excision with a high potential for incomplete excision and persistent disease, even after complete excision in some patients, and a high morbidity rate.

MeSH terms

  • Anus Neoplasms / pathology
  • Anus Neoplasms / surgery*
  • Bowen's Disease / pathology
  • Bowen's Disease / surgery*
  • Decision Trees
  • Follow-Up Studies
  • Humans
  • Neoplasm Recurrence, Local
  • Skin Neoplasms / pathology
  • Skin Neoplasms / surgery*
  • Treatment Outcome