pigmented bowen’s disease
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TRANSCRIPT
Pigmented Bowen’s Disease
Dr Ian Katz, March 2013www.southernsunpathology.com.au
What is Bowen’s disease?
• It is squamous cell carcinoma (SCC) that is still within the epidermis– i.e. is not invasive into the dermis
My classification of SCC
• Possibly two different pathways– Actinic pathway– Bowen’s pathway
Actinic Pathway
• Actinic keratosis• ?Intermediate lesion• Intraepidermal SCC• ? Early invasive SCC• SCC
Bowen’s pathway
• ? Precursor or early lesion• Bowen’s disease• ?possible invasive BD• Invasive BD type SCC
Invasive Bowen’s disease
• Can be really difficult to tell when there is early invasion
• Often extensive follicular involvement– Careful with topical therapy in hair-bearing skin
• Invasive BD type SCC said to have worse prognosis than regular SCC for the same depth (difficult to find this reference)
Who was Bowen
• John T Bowen, an American dermatologist• 1857–1940
The case
• 80 yo old man• Lots of skin cancers• Scaly, lightly pigmented lesion on right
forearm• No idea how long it had been there
Dermatoscopic features
• Scaly surface• Pigment but no network• Dot vessels
• All highly suggestive of pigmented Bowen’s disease
Histological features
• Full thickness dysplasia of epidermis with no evidence of invasive SCC
Treatment options
• Many options, none right or wrong• Depends on many doctor, patient factors eg– Affordability– Compliance– Equipment– Cost– Etc etc
Treatment options
• Excision• Curettage• Efudix• Aldara• Photodynamic therapy• Cryotherapy– And probably a few more
Dr Ian Katz
• Southern Sun Pathology• Sydney, Australia