The larger the defect, the more likely that flap rotation would be a more successful form of reconstruction. Skin grafts, particularly those that are circumferential, tend to undergo contracture and produce stricture at the ano-cutaneous margin created by the graft. Rotation flaps, on the other hand, are generally simple to outline and perform, and are rarely, if ever, associated with stricture at the anal cutaneous junction. No matter what the form of treatment, the presence of Bowen's disease at the margin, ie, the anal margin, is not uncommon on permanent section. Close observation of the patient for many years of follow-up is essential.
Most patients do extremely well over time.
Revision of the ano-cutaneous margin or the use of topical treatments, such as argon beam coagulation or topical fluorouracil, are best reserved for small areas of persistent Bowen's disease or for Bowen's disease that presents initially as the involvement of small patches of perianal skin. Inc. All rights reserved.