Indian Journal of Cancer Medknow Publications on behalf of Indian Cancer Society ISSN: 0019-509X EISSN: 1998-4774 Vol. 48, Num. 1, 2011, pp. 121-122

Indian Journal of Cancer, Vol. 48, No. 1, January-March, 2011, pp. 121-122

Letter to Editor

Bowen's disease over the abdomen - A histological pigmented variety

VV Pai¹, K Hanumanthayya¹, KN Naveen¹, R Rao², US Dinesh²

¹ Department of Dermatology, SDM College of Medical Sciences, Dharwad - 580 009, India
² Department of Pathology, SDM College of Medical Sciences, Dharwad - 580 009, India

Correspondence Address:
V V Pai
Department of Dermatology, SDM College of Medical Sciences, Dharwad - 580 009
India
docpai@rediffmail.com

Code Number: cn11026

Sir,

An 86-year-old woman presented at our OPD with lesions over the abdomen since 7 years. Initially presenting as a mole, the lesion gradually increased in size. There was history of oozing, crusting and itching on the lesion since last 2 weeks.

On examination, a well-defined plaque of size 11 × 8 cm was seen over the abdomen over the right groin area, with irregular borders, surface was moist with crusts, with of varied pigmentation [Figure - 1].

Hemogram, blood glucose, renal and liver parameters were normal. Biopsy showed the presence of large pleomorphic cells with hyperchromatic nuclei replacing the normal epidermis (wind-blown pattern). Melanin pigment was present in the epidermis, with some areas of dermis showing pigmentary incontinence [Figure - 2]a and b.

Therefore, a diagnosis of pigmented Bowen′s disease was made, and the patient was given topical 5-fluorouracil (5-FU) to be applied once daily.

Bowen′s disease is a form of in situ squamous cell carcinoma that was originally described by John T. Bowen, a Boston dermatologist, in 1912. The disease affects both skin and the mucosa and has potential to progress to invasive squamous cell carcinoma. ^[1]

Etiologically, both genital and non-genital skin lesions have been associated with human papillomavirus (HPV).^[2] Bowen′s disease has a predilection for the sun-exposed areas (particularly face and leg) in older individuals who have fair skin. ^[3] In our case, because of the unusual site and age of the patient, the exact etiological factor could not be determined.

Clinically, the initial change in Bowen′s disease is a small, red and slightly scaly area, which is asymptomatic and gradually enlarges in a irregular manner, which was seen in our case as well. Verrucous, nodular, eroded and pigmented variants also occur. ^[4]

Ulceration is a sign of development of invasive carcinoma and may be delayed for many years after the appearance of intraepidermal change. ^[4]

It is histopathologically characterized by the ′wind-blown′ pattern of the epidermis, with loss of polarity and presence of nuclear atypia and mitotic figures. Several histological variants have been described and more than one pattern may be present in different areas of the same lesion. The various patterns are psoriasiform, verrucous- hyperkeratotic, atrophic, pigmented and pagetoid. ^[2]

Various treatment modalities like surgery, curettage, cautery cryotherapy and topical therapies are widely in use for the treatment of this disease. Surgical excision is generally considered the treatment of choice for most lesions in this disease, if the size and location of the lesion permit, with a cure rate of 95%. ^[5] Topical agents like 5-FU and Imiqiumod can give good results and should be applied for 4-16 weeks once daily. ^[1]

Approximately 5% of Bowen′s disease progress to invasive squamous cell carcinoma, of which one-third may metastasize unless adequately treated. ^[1]

References

Copyright 2011 - Indian Journal of Cancer

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