2011.3-13.Bowen

                                                                                                                            article in PDF  
Our Dermatol Online. 2011; 2(3): 154-155
Date of submission: 21.03.2011 / acceptance: 28.04.2011
Conflicts of interest: None
 
 

 

BOWEN DISEASE – CLINIC, DERMOSCOPY, PATOLOGY

CHOROBA BOWENA – KLINIKA, DERMOSKOPIA, HISTOPATOLOGIA

Brzeziński Piotr1, Poklękowska Katarzyna2

16th Military Support Unit, Ustka, Poland,
2Mazowiecki Branch of the National Health Fund, Warsaw, Poland

Corresponding author: Dr. Piotr Brzeziński    e-mail: brzezoo77@yahoo.com


 
Bowen Disease is squamous cell carcinoma in situ in which the basement membrane is intact on histopathology. Lesions are usually solitary but may be multiple in 10-20 percent of cases. It typically presents as an erythematous enlarging plaque having irregular borders with scaling and crusting. The lesions may be fissured or verrucous or, rarely, pigmented. Ulceration may occur and is often a sign that invasive disease is developing. The risk of progression of Bowen disease to invasive carcinoma is about 3%. Bowen disease is most commonly found in patients over 60 years old. Oher risk factors: include chronic sun exposure, immunosuppression, arsenic exposure and cutaneous human papillomavirus (HPV- 16, 18, 34 i 48) infection.
 
Dermoscopy:
The majority of cases of Bowen disease revealed a peculiar dermoscopic pattern characterized by glomerular vessels (90%) and a scaly surface (90%). In addition, in pigmented BD small brown globules regularly packed in a patchy distribution (90%), and structureless grey to brown pig-mentation (80%).
 
Histopathology:
Proliferation of numerous atypical keratinocytes throughout the entire thickness of the epidermis with hyperkeratosis, mitotic figures, multinucleated cells and dyskeratotic cells, full thickness dysplasia of the squamous epithelum, disorderly maturation of the epidermis, parakeratosis and loss of granular layer. Histological patterns include: psoriasiform pattern, atrophic form, verrucous hyperkeratotic type, irregular variant, pigmented type and pagetoid variant. Rarely mucinous and sebaceous metaplasia may be noted.
 
Figure 1. Dermoscopy. Glomerular vessels
Figure 2. Erythematous lessions having irregular borders with crusting
Figure 3. Histopathology. Proliferation of numerous atypical keratinocytes, dyskeratotic cells, full thickness dysplasia of the squamous epithelum
 
REFERENCES
1. Osmun WE, Parr J: Question: Can you identify this condition? Bowen disease. Can Fam Physician. 2010; 56: 665.
2. Gupta S, Nutan, Dogra S, Kanwar AJ: Bowen Disease over photoprotected site in an Indian male. Dermatol Online J. 2009; 15: 16.
3. Zalaudek I, Di Stefani A, Argenziano G: The specific dermoscopic criteria of Bowen's disease. J Eur Acad Dermatol Venereol. 2006; 20: 361-362.


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