Fougelberg Julia, Ek Hampus, Claeson Magdalena, Paoli John
Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Region Västra Götaland, Sahlgrenska University Hospital, Department of Dermatology and Venereology, Gothenburg, Sweden.
Dermatol Pract Concept. 2021 Apr 12;11(2):e2021046. doi: 10.5826/dpc.1102a46. eCollection 2021 Mar.
One common treatment for Bowen disease (BD) is surgical excision, but there is no international consensus on the appropriate surgical margins.
This study examined what factors affect the rate of incomplete excision of BD.
Clinicopathological data potentially linked to surgical outcome (complete or incomplete excision) were retrospectively collected from medical and histopathological records on all surgically excised BD lesions diagnosed at Sahlgrenska University Hospital in Gothenburg, Sweden during 2014-2015. Data were analyzed with two definitions of incomplete excision: less strict (ie, BD present at the surgical margin) and strict (ie, dysplasia present at the surgical margin).
In total, 463 BD lesions among 408 patients were included. With the less strict definition, 3 factors were associated with significantly higher rates of incomplete excision: surgical margins <3 mm, a less experienced surgeon, and use of punch biopsy excision. The same factors plus a tumor location on the head and neck area or upper extremities were associated with significantly higher rates of incomplete excision using the strict definition. After adjustment for confounders, less experience was independently associated with incomplete excision using the less strict definition, whereas less experience and location on the head and neck area or upper extremities were independently associated with incomplete excision using the strict definition. Surgeon specialty was not associated with incomplete excision regardless of the definition.
When removing BD surgically, an elliptical excision with surgical margins ≥3 mm carried out by an experienced surgeon should be recommended. Surgical margins may need to be adjusted depending on body site.
鲍温病（BD）的一种常见治疗方法是手术切除，但对于合适的手术切缘尚无国际共识。
本研究探讨了哪些因素会影响BD的切除不完全率。
回顾性收集了2014 - 2015年期间在瑞典哥德堡的萨尔格伦斯卡大学医院诊断并接受手术切除的所有BD病变的临床病理数据，这些数据可能与手术结果（完全或不完全切除）相关，数据来自医学和组织病理学记录。采用两种不完全切除的定义进行数据分析：较宽松的定义（即手术切缘存在BD）和严格的定义（即手术切缘存在发育异常）。
共纳入408例患者的463个BD病变。按照较宽松的定义，有3个因素与明显更高的切除不完全率相关：手术切缘<3 mm、手术经验较少的外科医生以及采用冲孔活检切除术。按照严格的定义，相同的因素加上肿瘤位于头颈部区域或上肢与明显更高的切除不完全率相关。在对混杂因素进行调整后，手术经验较少独立地与采用较宽松定义的不完全切除相关，而手术经验较少以及肿瘤位于头颈部区域或上肢独立地与采用严格定义的不完全切除相关。无论采用哪种定义，外科医生的专业与不完全切除均无关。
手术切除BD时，建议由经验丰富的外科医生进行手术切缘≥3 mm的椭圆形切除。手术切缘可能需要根据身体部位进行调整。
