表皮内癌における手術療法と非手術療法との比較

Comparison of Surgical and Non-Surgical Treatments for Actinic Keratosis and Bowenʼs Disease

はじめに

　日光角化症（actinic keratosis：以下，AK）とボーエン病（Bowenʼs disease：以下，BD）は日常診療で比較的よく遭遇する表皮内癌（以下，SCC in situ）である。治療として手術療法と非手術療法に分けられ，非手術療法は凍結療法や外用療法，光線力学療法（photodynamic therapy：以下，PDT）がある。どの治療が治療効果も高く，比較的安全に施行できるのかを知ることは重要と考える。本稿ではAKとBDの鑑別点と治療法の比較について報告する。

　Actinic keratosis (AK) and Bowenʼs disease (BD) are commonly encountered in daily dermatology clinical practice. The treatment options for AK and BD are divided into surgical and non-surgical therapies, e.g., cryotherapy, topical therapy (such as imiquimod and 5-fluorouracil [5-FU]), and photodynamic therapy. Two studies have compared the therapeutic effects of surgical therapy and cryotherapy, and neither study demonstrated a clear significant difference. In addition, no significant differences in outcomes were observed in the study comparing cryotherapy, imiquimod, and 5-FU. The results obtained with cryotherapy and photodynamic therapy also showed no significant differences. Based on these reports, it appears that therapeutic effects can be achieved for patients with AK or BD regardless of the chosen treatment. It is important to discuss the available treatment options with the patient (and in some cases his/her family members) and to select the initial treatment based on the patientʼs individual background.