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Photodynamic therapy for residual neoplasms of the perianal skin
M A Runfola1, T K Weber, M A Rodriguez-Bigas
1Department of Surgical Oncology, Roswell Park Cancer Institute, State University of New York at Buffalo, 14263, USA.
Purpose:
The aim of this study was to evaluate the efficacy of photodynamic therapy in the management of residual neoplasms of the perianal skin.
Methods:
This is a retrospective review. Five patients with pathologic confirmation of residual perianal neoplasms were treated with photodynamic therapy. There were three females. The mean age was 52 (range, 33-79) years. Pathology consisted of Bowen's disease in two patients, squamous-cell carcinoma in two patients, and extramammary Paget's disease in one patient. Four patients received one photodynamic therapy treatment and one patient received two treatments three months apart.
Results:
Treatment was followed by immediate perianal erythema, subsequent blister formation in 36 to 48 hours, and sloughing of the treated area in 72 hours. With a mean follow-up of 5.2 (range, 1-8) years, there were two recurrences. One recurrence was in a patient four years after treatment for Paget's disease, and the other was in a patient nine months after treatment for Bowen's disease. The latter was managed successfully with wide local excision. Treatment-related toxicities included significant perianal pain in four patients, controlled with analgesia management.
Conclusions:
Photodynamic therapy can successfully be used after wide local excision for residual neoplasms of the perianal skin. Treatment can be rendered with acceptable morbidity.