|LETTER TO EDITOR
|Year : 2011 | Volume
| Issue : 1 | Page : 121-122
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
|Date of Web Publication||10-Feb-2011|
V V Pai
Department of Dermatology, SDM College of Medical Sciences, Dharwad - 580 009
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Pai V V, Hanumanthayya K, Naveen K N, Rao R, Dinesh U S. Bowen's disease over the abdomen - A histological pigmented variety. Indian J Cancer 2011;48:121-2
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].
|Figure 1: Plaque over the abdomen with irregular border and varied pigmentation|
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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.
|Figure 2: (a) Photomicrograph demonstrating pleomorphic cells with hyperchromatic nuclei in the epidermis in a 'wind-blown' pattern (×40). (b) Melanin pigment in the epidermis with pigmentary incontinence into the dermis (×100)|
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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. 
Etiologically, both genital and non-genital skin lesions have been associated with human papillomavirus (HPV). Bowen's disease has a predilection for the sun-exposed areas (particularly face and leg) in older individuals who have fair skin.  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. 
Ulceration is a sign of development of invasive carcinoma and may be delayed for many years after the appearance of intraepidermal change. 
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. 
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%.  Topical agents like 5-FU and Imiqiumod can give good results and should be applied for 4-16 weeks once daily. 
Approximately 5% of Bowen's disease progress to invasive squamous cell carcinoma, of which one-third may metastasize unless adequately treated. 
| » References|| |
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|2.||Weedon D. Skin pathology. 2 nd ed. London: Churchhill Livingstone; 2002. p. 763-5. |
|3.||Cox NH. Body distribution of Bowen's disease. Br J Dermatol 1994;130:714-6. |
|4.||Mackie RM, Quinn AG. Epidermal skin tumors. Rook's textbook of dermatology. In: Burns T, Breathnach S, Cook N, Griffith C, editors. 7 th ed. Oxford: Blackwell publishing; 2004. P. 36.33-6. |
|5.||Cox NH, Eedy DJ, Morton CA. Guidelines for management of Bowen's disease. British associaton of dermatologists. Br J dermatol 1999;141:633-41. |
[Figure 1], [Figure 2]
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