Wound healing on the lower leg after radiotherapy or cryotherapy of Bowen's disease and other malignant skin lesions

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Abstract
To investigate lower leg wound healing after treatment of skin tumours, the results of external beam radiotherapy were assessed for 141 lesions in 91 patients. Poor healing or failure to heal occurred in 33%, and was related to the age of the patients, the diameter of the radiotherapy field, and the dose and energy of radiotherapy used. No effect of fractionation on healing was apparent, but only 14% of patients were exposed to regimens with a nominal standard dose of over 1800 rets. Age > 90 years, field diameter > 4 cm and dose > 3000 cGy were all associated with a risk of impaired healing of over 50%. The most frequent single diagnosis (59 lesions) in the radiotherapy patients was Bowen's disease. The results of wound healing in these patients were compared with the results of cryotherapy to 82 lower leg Bowen's disease lesions in 49 dermatology patients. Only 2% of the cryotherapy lesions failed to heal compared with 20% of the radiotherapy wounds, although 6% of cryotherapy cases had local recurrence compared with none in the radiotherapy group. Serial overlapping cryotherapy fields of up to 2 cm diameter were shown to be a valid treatment option for Bowen's disease, as no patients had therapy-related failure to heal. To avoid the requirement for potentially more difficult post-radiotherapy salvage surgery, intra-epidermal non-invasive skin tumours > 4 cm in diameter on the lower leg are probably initially best treated by a primary surgical procedure or by staged cryotherapy. Invasive carcinoma of > 4 cm diameter is best treated by surgical excision.(ABSTRACT TRUNCATED AT 250 WORDS)

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