Bowen's Disease

babiesmom5

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I am so glad your dermatologist wants to pursue the Co2 laser treatment 'ablation". From what I read, this is the most effective treatment; far superior to the Imiquimod or even Cryotheraphy. To perform this procedure, the cat must be fully anesthesized. With a younger cat such as yours, this should not pose a problem. If I were you,( with your vets approval), I would definately go for it. My only hesitation is my cat is 19 1/2 years old with CKD, so try to minimize needs for anesthesia. Yes, it is more expensive, but I think results are far more long lasting and effective. Also, this treatment method removes the lesions on the skin, thus preventing it from going deeper and becoming (more lethal) Squamous Cell Carcinoma. Here is a very good article describing this treatment along with good pictures.

Bowenoid in situ carcinoma in cats: CO2 laser treatment

I do hope your cat can be evaluated by a cardiologist, which will be helpful prior to any anesthesia.

After my experience with Imiquimod and Cryotheraphy, I think Co2 laser is the only way to go in attacking this very persistent Bowen's Disease. Be very thankful your cats kidneys allow for this option. I am happy for you and look forward to following you and your cat's progress with high hopes!
 
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Black&White

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Thank you for that reply and encouragement, we have a few updates and I would be interested in your thoughts about this. My feeling is that we should simply get the ultrasound done and aim to have the ablation. But I will explain. The derm in Vancouver who does the ablation has suggested we see an oncologist first, also in Vancouver, to assess her condition and discuss a possible alternative treatment plan. The reason is that the derm would need to do an initial consult then book the ablation on another day which means two trips to Vancouver. So they suggested seeing an oncologist first, who may have another idea.

There is also the issue of her level 1 heart murmur, we either would need to have an ultrasound done or have a veterinary anesthesiologist present during the ablation which adds to the cost. They are suggesting to see oncology first which may mean an anesthetic would not be required.

My Vet just emailed about the oncologist which I will post here:

The cost of the initial consult with Dr Charny would be $265.00 plus tax,
plus your travel time and expenses over to Vancouver. She would then examine
and go through what has been done and assess how she has responded,
from there she would present you a treatment plan, with costs and an idea of
what to expect from the treatment. The idea of going to an oncologist is
that she may have an option that does not require an anesthetic (which the
laser ablation does). I really do not know what the options will be and what
the costs would be. The Imiquimod, is the first line treatment that is
recommended.
My sense from our discussion here on the forum is that they will simply suggest having the ultrasound done and the ablation. Do you think there would be another alternative that is better?

In the last two weeks I have been shaving the spots with a shaving razor, which actually works quite well, and dabbing her chest scabs with water. Just yesterday I felt as though we have reached a turning point with the Imiquimod, the scabs on her chest are greatly reduced, and finally flaking off completely on one side. The ones on her head seem to be gone, and her cheeks have also greatly reduced and seem to be almost gone on one side. We skipped a day to give her a bit of a break and I noticed her mood and energy was very good yesterday. I hugged her and told her we are beating this and she really purred, I know she feels it too! :)
 
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Black&White

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Looking at the chest scabs during her application today, I have to say they are very stubborn, and after 3 months now, should I not expect they would be gone? While the ones on her head are almost gone, and one cheek is responding well, the other cheek has some very persistent scabs and i see some spreading. Some respond very well, in 2-3 sessions they virtually disappear, and others seem to be stuck...
 

babiesmom5

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I apologize for my delay in responding. We were out of town yesterday taking my girl to her Cardiologist for follow up. She is fine; no changes from last time so we can put the heart issue on the back burner now.

My understanding of Bowen's disease is that it is a slow growing type of cancer on the skin. As long as it remains on the dermal layer (in situ) it is manageable dermatologically. My dermatologist never suggested an oncologist consult because it was in situ per the biopsy. Now, if it had penetrated beneath the dermal layers, then it becomes Squamous Cell Carcinoma and that is a another ballgame. I think at that point, I would have been referred to an Oncologist who is there at the same specialty clinic.

As far as options an oncologist could suggest from the standpoint of Bowen's disease in situ, I am not aware of any other treatment options other than Imiquimod, Cryotheraphy, surgery, or Co2 Ablation. As the article I previously referenced here states, the Co2 Laser ablation is the superior treatment in preventing advancement of the disease into Squamous Cell Carcinoma.

Your cat, like mine is dealing with multiple lesions. Some are more resistant than others. For mine, it was the head which has taken 4 passes of the Cryotheraphy pen, and this is after surgery, plus months of Imiquimod. It now appears under control, but will likely take additional treatments if/when it returns.

In your case it appears the chest scabs are the most resistant. If I understand correctly, you have not had the chest scabs biopsied? Do you see them improved significantly? Three months does seem like a long time not to have seen significant improvement...if they are still dermal (in situ). You might want to ask about possibly biopsy of this to ensure it is indeed still dermal. They can do this quickly with a local anesthetic. If this is the worst area, and if it is still dermal, then I would go for Co2 ablation of all of them.

So, I would start with the Dermatologist consult but also inquire about biopsy of the worst/unresponsive lesions. I think this will more clearly bring into focus your next step. I hope this helps some. There are no easy answers here, but I think some valuable insights will be gleaned by having a Dermatological evaluation of all the lesions and progress made thus far.
 
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Black&White

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Thank you so much! That was very helpful to read, and glad to hear your kitty is doing well :)

I talked to the derm office in Vancouver today and asked why they suggest to see an oncologist, and mentioned what you said about the limited treatment options. They maintained that there might be some 'new' treatment options that have been developed more recently, and that they still recommend it. But she said a remote consult with them was still an option - they would look at recent photos compared to those taken Oct 1st by my vet, go over her files, and perhaps recommend a new biopsy. I could then go over and have the ablation done in one day.

There is no indication from anyone at this point that it might have progressed below the skin, unless they suspect from the weight loss. But her weight has stabilized when we last checked. I would think before seeing an oncologist, they would need to do another biopsy to determine if it has advanced to Squamous Cell Carcinoma. The derm clinic seems to believe there may be other options beyond what they offer. I'm not sure about their reasoning, perhaps it would give one more perspective beyond there own?

A biopsy was taken in July, in three places, including one on her chest. They said they are in situ. Her chest lesions have improved, they were thick black scabs 3 weeks ago, and now they are quite thin and pinkish. The most significant changes have happened in the last three weeks since I started dabbing them with water, using a coarse cloth to rub them, and shave the area with a razor. That seems to have helped. One lesion is close to gone on her chest, but the other is more resistant.

Thank you again for your help, it is always a pleasure to read your replies! :)
 

babiesmom5

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I am getting a "sense" here that the dermatologist wants to defer to the possible expertise/knowledge of the oncologist. It has been my experience that specialists (both doctors and vets) do not want to step on the toes of another specialist or prescribe outside their area of expertise, thus exposing themselves to possible liability. I think your dermatologist would feel more comfortable having the oncologist weigh in prior to his/her evaluation. So, I think it may be to your advantage to get the remote consult with the oncologist, see what they say re treatment progress, any new treatments available. It certainly couldn't hurt and might provide some new insights. For sure, it would give "cover" to the dermatologist.

It does sound from all indications that the lesions are all still "in situ" which is good news. While Bowen's is a very persistent disease, you have certainly been a very good and proactive mom...keep it up!
 
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Black&White

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Thank you again, you really have a very clear headed way of seeing things! That's what I'll do, thank you :)
 
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