There are multiple ways to manage sun spots including Bowens/IECs. Treatment modalities will depend on the location and size of the cancer, the number of lesions, the degree of functional impairment and costs. Each modality has both advantages and disadvantages.
Cryotherapy or liquid nitrogen
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Liquid nitrogen can be an excellent method of treating IECs. Most cases will require a double -freeze cycle of cryotherapy. This treatment is not recommended for IECs below the knee, as poor healing may occur. Solar keratosis can be treated with this modality.
Creams
Imiquimod (Aldara), or 5-fluorouracil (Efudix) are effective in the treatment of Bowen disease & solar keratosis. Clinical studies have shown cure rates approaching 80-90%. Treatment appears to be most successful when these creams are applied for 6-16 weeks.
Curettage and Electrocautery
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When small patches of IECs are present they may be treated via curettage and cautery. A local anaesthetic is given prior to the procedure to prevent pain and discomfort. Hypertrophic sun spots are also treated with this method.
Photodynamic therapy (PDT)
Photodynamic therapy or PDT can be an excellent non-surgical method of treating skin cancers such as Bowen’s/ IEC’ as well as sun spots. PDT uses a photosensitive cream called 5-aminolevulinic acid or methyl aminolevulinate, that is applied to the skin cancer. The cancerous cells of Bowens/ IEC take up this chemical over a period of 3 hours. A low-level laser light then activates the chemical, and destroys the skin cancer cells. Patients will require two treatments spaced a week or two apart.
PDT is ideal for IECs on cosmetically sensitive areas such as the face, or for IECs that occur on the legs where healing can be a problem. PDT can also be used for multiple or large IECs. The benefit of PDT is that it selectively targets neoplastic cells without affecting the surrounding epidermis. This results in improved cosmetic outcomes, and faster healing times.
Laser therapy
Ablative lasers such as CO2 or erbium can be used to treat sun spots, precancerous lesions & IECs.
Surgery
Surgery is the ideal method of treating IECs in certain areas including-
- IECs associated in terminal hair bearing areas, such as the scalp or brows
- IECs that occur in the nail (periungual IECs)
- IECs that occur on the lip
- Recurrent IECs that fail to respond to other treatments.
Surgery has the highest cure rate for Bowens/ IECs but is an overkill for the mangement of sun spots.
Radiotherapy
Consider referral for consideration of radiotherapy for poor surgical candidates, or patients with multiple lesions.
Peels
I do perform medium to deep peels including Jessner-TCA or phenol croton oil peels for field changes, including solar keratosis. Mild sun damage can be treated with high strength AHA-glycolic acid 70%.
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