Treatment of Bowen’s Disease on the Genitals

Click here to download a copy of a publication from the American Society for Dermatologic Surgery Inc 2011 on Treatment of Bowen's Disease on Penis with Low Concentration of a Standard Mixture of Solasodine Glycosides and Liquid Nitrogen

So what does this all mean in layman’s terms?

Squamous Cell Carcinoma (SCC) is the most common skin cancer in the penile area.  Being so close to the glands, there is a risk that the cancer could spread through the body through these glands.  Treatment is usual aggressive using Mohs surgery.  Disfigurement and dis-function can occur after this aggressive surgery, as you can imagine this can create psychological distress.  This is why when the SCC is superficial (Bowen’s Disease), it is preferred to use a topical treatment.  These topical treatments may be: –

  • 5-fluorouracil;
  • imiquimod;
  • neodymium-doped yttrium aluminium garnet;
  • carbon dioxide;
  • laser; and
  • localised radiation.

This article did a case study using a combination of BEC5 (Curaderm BEC5 – solasodine glycosides) and liquid nitrogen used on the thicken genital warts that were present.

Case Report
The case study was done a 52 year old man with a long history of verrucous condylomata acuminata (large confluent nodules) and he presented with a arythematous macule (another word for a red spot) on this penis.  He never experience itching, bleeding or pain and the lesion did not resemble genital warts.  A biopsy on the lesion showed Bowen’s Disease (SCC).

Treatment 1
The man went trough 2 courses of topical 5% imiquimod cream (Aldara, Graceway Pharmaceuticals, Bristol, TN) over 2 years.  The inial response was ok but the lesion returned after a year.

Treatment 2
The man refused to undergo Mohs surgery treatment due to the worry of disfigurement and loss of function.  After doing his own research decides he want to undergo treatment with Curaderm BEC5 (BEC5 – solasodine glycosides) – Dr. Cham’s Curaderm, Curaderm Global Ltd, Queensland Australia.

The man understood that Curaderm had not been used to treat a condition like his before and that is may not be a cure but he still wanted to proceed with the treatment.

He treated the lesion topically twice a day with Curaderm after cleaning the areas with a mild antiseptic and then covered it with micropore tape.

Liquid Nitrogen was also used to help reduced the thicken skin.

After 2 months the lesion showed minimal response.  After 4 months there was an improvement and after 9 months even greater improvement as noted.

After 10 months the lesion was no longer present and the treatment with Curaderm was stopped.

No reoccurrence of the lesion occurred over the 2 years of observation after the treatment was stopped.

The man experienced the flowing side effects during treatment:-

  • local irritation; and
  • local ulceration.

The side effects resolved them selves when treatment was stopped.

Discussion
Penile cancer occurs in less than 1% of the male population in the western countries but can occur in up to 20% of the population in undeveloped countries.  90-95% of these cancers are SCC.

The usual occur in older men 50-80 years in age and in men who are not circumcised early in life.  Addition factors that added risk were poor hygiene, smoking and phimosis (the foreskin cannot be fully retracted over the glans penis).  SCC’s on the penis can be Erythroplasia of Queyrat or Bowen’s Disease and can progress into invasive SCC if it spreads through the glads into the body.  The Human Papilloma Virus (a virus that can cause genital warts) has been reported in 15-80% of men with penile cancer but there is no distinct relationship.

Mohs surgery is a safe and effective treatment option that allows for the best possible cure rate, minimal tissue sparing and complete margin control.  It may be consider the surgical treatment of choice for Bowen’s disease on the genitals.  With the risk of spreading treatment must be extensive and quick to reduce risk.

For superficial lesions, nonsurgical options are the best treatment such as: –

  • 5-fluorouracil;
  • imiquimod;
  • neodymium-doped yttrium aluminium garnet;
  • carbon dioxide;
  • laser;
  • localised radiation; and
  • BEC5 (Curaderm BEC5 – solasodine glycosides)

The main ingredient in BEC5 is a purified extract from an Australian plant known as Devil’s Apple (Solanum Sodomaeum) and is also found in Eggplant.    Curaderm is a relatively new product and was introduced by Dr Cham (Biochemist) into the medical world after he heard a folk tale about a cow that cured its tumour by constantly rubbing its face in a patch of these weeds.  The active ingredients in BEC5 is rhamnose sugar moeties and these ingredient do not occurs naturally in the mammalian species but cancer cells do have the receptors for these sugars.  When the BEC5 molecules bind to cancer cells they lead to the destruction of the cells.

As far as the article writers know, Curaderm had not bee used to treat a penile SCC.  Previous studies of topical treatment has been on the face, trunk and limbs.  During treatment patents developed inflammation around the lesion and ulceration and healing by  creation of new tissue, this is when treatment was ended.

Although these side effects may be bothersome to some people, the man continued his testament as he preferred any of these side effects to surgical treatment that may lead to disfigurement and loss of function.  He did not consider taking “holidays”  and did not complain about the pain or inflammation.

Clinical studies have showed over a 3 year period that treatment of 124 lesions did not reoccur when Curaderm was used.

The man experienced a typical response to Curaderm including inflammation and ulceration to the treated skin.  There was a complete regression of his lesion.  The combination of Curaderm and liquid nitrogen was adventurous and it limited the pain and risk of scarring from excess use use liquid nitrogen alone of surgery.

The article reports a successful treatment of Bowen’s Disease on the penis using Curaderm.  The tissue sparing technique preserved functionality and may be a great alternative against other more-destructive treatment options for Bowen’s Disease on the penis.  Further long-term, prospective studies with larger patient numbers is recommended to further assess this treatment of SCC on the penis.

Click here to see pictures of this treatment.