RESUMEN
PURPOSE: Merkel cell carcinoma (MCC) is a rare neuroendocrine tumor of the skin, which mainly occurs in the sun exposed sites of white patients over 65 years, with a higher recurrence and metastasis rate. Clinically, MCC overlapping Bowen's disease (BD) is a very rare subtype of MCC. Few cases in the literature have been described and the management is not well defined. We summarize and update the epidemiology, clinical and histopathological features, metastasis characteristics, local recurrence rate and management of it by presenting two cases of MCC overlapping BD and reviewing the literature over the last 11 years. DESIGN: We consulted databases from PubMed, ResearchGate and Google Scholar by MeSh "Merkel cell carcinoma" and "Bowen's disease", "Bowen disease" or "squamous cell carcinoma in situ", from January 2013 to December 2023 and reviewed the literatures. We reported two additional cases. RESULTS: Total 13 cases of MCC overlapping BD were retrospectively analyzed, in whom mainly in elderly women over 70 years, the skin lesions were primarily located on the faces, followed by the extremities and trunk. Most of them were asymptomatic, firm, dark red nodules arising on rapidly growing red or dark brown patches, or presenting as isolated nodules. Dermoscopy evaluation was rarely performed in the pre-operative diagnostic setting. All cases were confirmed by histopathology and immunohistochemistry. The most definitive treatment was extended local excision, but local recurrences were common. Of the 13 cases, 4 cases experienced local or distant metastasis. One suffered from an in-transit recurrence of MCC on the ipsilateral leg after local excision and lymph node dissection, whose metastasis completely subsided after avelumab treatment and without recurrence or metastasis during 6 months of follow-up. CONCLUSIONS: MCC overlapping BD is a very rare skin tumor mainly predisposed on the faces, with high misdiagnosis rate and recurrence rate. Advanced disease at diagnosis is a poor prognostic factor, suggesting that earlier detection may improve outcome. The acronym, AEIOUN, has been proposed to aid in clinical identification. Our reports and the literature review can provide a better awareness and management of it.
Asunto(s)
Enfermedad de Bowen , Carcinoma de Células de Merkel , Neoplasias Cutáneas , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedad de Bowen/patología , Enfermedad de Bowen/diagnóstico , Enfermedad de Bowen/terapia , Carcinoma de Células de Merkel/patología , Carcinoma de Células de Merkel/terapia , Carcinoma de Células de Merkel/diagnóstico , Recurrencia Local de Neoplasia/patología , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/diagnósticoRESUMEN
OBJECTIVE: By presenting a case study on multiple instances of Bowen's disease and the consistent use of narrow-band ultraviolet B (NB-UVB) phototherapy over a three-year period, our aim is to enhance the comprehension of domestic clinicians regarding the disease. Additionally, we seek to review existing literature, encouraging dermatologists to consider clinical secondary primary lesion diagnoses. METHOD: Our approach involves analyzing a diagnosed case of multiple Bowen's disease, examining clinical manifestations, histopathology, imaging results, and treatment methods related to NB-UVB phototherapy. We aim to facilitate discussion and understanding through a comprehensive literature analysis. RESULTS: An elderly male with a 30-year history of psoriasis vulgaris initiated continuous NB-UVB therapy three years ago. A year later, he developed red patches and plaques with distinct borders and scaly surfaces on his face, trunk, lower extremities, and scrotum. Histopathological examination confirmed Bowen's disease. Treatment involved liquid nitrogen cryotherapy, with no recurrence observed during the one-year follow-up. CONCLUSION: This case highlights that Bowen's disease, typically solitary, can manifest as multiple instances, especially in individuals with a history of psoriasis vulgaris. While NB-UVB stands as the primary treatment for psoriasis vulgaris, caution is warranted due to the potential risk of skin tumor induction with prolonged high-dose usage. Clinicians should be vigilant in monitoring and assessing the long-term implications of such therapies.
Asunto(s)
Enfermedad de Bowen , Psoriasis , Neoplasias Cutáneas , Terapia Ultravioleta , Humanos , Enfermedad de Bowen/terapia , Enfermedad de Bowen/diagnóstico , Enfermedad de Bowen/patología , Masculino , Terapia Ultravioleta/efectos adversos , Terapia Ultravioleta/métodos , Neoplasias Cutáneas/etiología , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/radioterapia , Neoplasias Cutáneas/diagnóstico , Psoriasis/diagnóstico , Psoriasis/radioterapia , Psoriasis/terapia , Anciano , Crioterapia/efectos adversosAsunto(s)
Neoplasias del Ano , Enfermedad de Bowen , Carcinoma de Células Escamosas , Neoplasias Cutáneas , Lesiones Intraepiteliales Escamosas , Humanos , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/terapia , Carcinoma de Células Escamosas/patología , Enfermedad de Bowen/diagnóstico , Enfermedad de Bowen/terapia , Enfermedad de Bowen/patología , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/terapia , Neoplasias Cutáneas/patología , DermatólogosAsunto(s)
Neoplasias del Ano , Enfermedad de Bowen , Carcinoma de Células Escamosas , Neoplasias Cutáneas , Lesiones Intraepiteliales Escamosas , Humanos , Enfermedad de Bowen/diagnóstico , Enfermedad de Bowen/terapia , Enfermedad de Bowen/patología , Dermatólogos , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/terapia , Carcinoma de Células Escamosas/patología , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/terapia , Neoplasias Cutáneas/patologíaRESUMEN
Bowen's disease (BD) is an intraepidermal squamous cell carcinoma (SCC) with the capacity to become invasive SCC giving rise to distant metastasis. In rare cases it can be associated with human papillomavirus (HPV) infection, specifically with HPV types 16, 18, 31, 32, and 34. Here we report a case of an immunocompetent white male, age 37, with an erythematous, irregularly-shaped patch in his suprapubic region, appearing 1 year after treatment for condylomata acuminata with cryotherapy and podophyllin in the same area. At the time of clinically active disease, a urethral smear was positive for high-risk HPV types. The lesion was considered a scar by several physicians because it emerged in an area of previous postinflammatory hyperpigmentation. The aim of this report is to raise awareness of the emerging causative association between anogenital HPV infection and the development of BD, which was the possible etiological agent in the case of the patient presented here. Hereby we also advocate primary preventive measures in terms of safe sexual habits and HPV vaccination.
Asunto(s)
Enfermedad de Bowen , Condiloma Acuminado , Infecciones por Papillomavirus , Neoplasias Cutáneas , Adulto , Enfermedad de Bowen/etiología , Enfermedad de Bowen/terapia , Condiloma Acuminado/complicaciones , Condiloma Acuminado/terapia , Humanos , Masculino , Papillomaviridae , Infecciones por Papillomavirus/complicaciones , Neoplasias Cutáneas/complicacionesRESUMEN
Squamous cell carcinoma in situ (SCCis), also known as Bowen's disease, is a common superficial malignancy of the skin. Treatment of SCCis is important to prevent invasion into the dermis as well as metastases. Treatment of SCCis may be challenging based on the location of the tumor, advanced age, immunosuppression, medical comorbidities, or desire for noninvasive treatment. SCCis on the lower leg can be particularly challenging to treat due to poor wound healing in the setting of suboptimal circulation. This report reviews the evidence for various treatment options of SCCis, including their advantages, disadvantages, and efficacy, with an emphasis on treatment of SCCis of the lower extremity. Treatment options discussed in this contribution include wide local excision, Mohs micrographic surgery, cryotherapy, curettage, imiqimod, 5-fluorouracil, 5-fluorouracil and calcipotriol, ingenol mebutate, tazarotene, photodynamic therapy, acitretin, laser therapy, and radiotherapy.
Asunto(s)
Enfermedad de Bowen , Carcinoma in Situ , Carcinoma de Células Escamosas , Neoplasias Cutáneas , Enfermedad de Bowen/terapia , Carcinoma in Situ/cirugía , Carcinoma de Células Escamosas/cirugía , Humanos , Extremidad Inferior , Cirugía de Mohs , Neoplasias Cutáneas/cirugíaAsunto(s)
Enfermedad de Bowen , Queratosis Actínica , Heridas y Lesiones , Anciano de 80 o más Años , Enfermedad de Bowen/complicaciones , Enfermedad de Bowen/terapia , Vendajes de Compresión/normas , Femenino , Humanos , Queratosis Actínica/complicaciones , Queratosis Actínica/terapia , Pierna/patología , Neoplasias Cutáneas/terapia , Resultado del Tratamiento , Heridas y Lesiones/terapiaRESUMEN
The periocular region sees high rates of cancer compared to the rest of the body and can be affected by several unique tumors. Treatment typically involves surgical excision, although adjunctive therapies and prognosis vary depending on the diagnosis. Basal cell carcinoma (BCC) is the most common malignancy affecting this region and should be excised promptly. This is followed by squamous cell carcinoma, which is often mistaken for BCC but is treated similarly. Melanoma is less common but more deadly, with relatively high rates of metastasis and death. Rare tumors that may be found in this region include sebaceous carcinoma, Merkel cell carcinoma, and microcystic adnexal carcinoma. While uncommon, these tumors are associated with poor outcomes and frequent recurrence. Recognition of periocular skin cancer is an important skill for primary care physicians, as prompt diagnosis and treatment can be sight or life-saving.
Asunto(s)
Antineoplásicos/uso terapéutico , Carcinoma Basocelular/terapia , Carcinoma de Células Escamosas/terapia , Neoplasias de los Párpados/terapia , Melanoma/terapia , Cirugía de Mohs , Neoplasias Cutáneas/terapia , Adenocarcinoma Sebáceo/diagnóstico , Adenocarcinoma Sebáceo/terapia , Antineoplásicos Inmunológicos/uso terapéutico , Enfermedad de Bowen/diagnóstico , Enfermedad de Bowen/terapia , Carcinoma Basocelular/diagnóstico , Carcinoma de Células de Merkel/diagnóstico , Carcinoma de Células de Merkel/terapia , Carcinoma de Células Escamosas/diagnóstico , Procedimientos Quirúrgicos Dermatologicos , Neoplasias de los Párpados/diagnóstico , Neoplasias de Cabeza y Cuello/diagnóstico , Neoplasias de Cabeza y Cuello/terapia , Humanos , Queratosis Actínica/diagnóstico , Queratosis Actínica/terapia , Melanoma/diagnóstico , Neoplasias de Anexos y Apéndices de Piel/diagnóstico , Neoplasias de Anexos y Apéndices de Piel/terapia , Neoplasias de las Glándulas Sebáceas/diagnóstico , Neoplasias de las Glándulas Sebáceas/terapia , Neoplasias Cutáneas/diagnósticoAsunto(s)
Enfermedad de Bowen/terapia , Neoplasias del Pene/terapia , Lesiones Precancerosas/terapia , Neoplasias Cutáneas/terapia , Enfermedad de Bowen/patología , Legrado , Humanos , Masculino , Persona de Mediana Edad , Neoplasias del Pene/patología , Fotoquimioterapia , Lesiones Precancerosas/patología , Neoplasias Cutáneas/patologíaRESUMEN
A 65-year-old Japanese man presented with a dome-shaped nodule, the base of which was contiguous with a dull brown plaque, on the left leg. After local excision of the cutaneous lesion and left inguinal lymph node dissection, several dermal and subcutaneous nodules developed successively on the left lower extremity. Hematoxylin-eosin staining of the primary cutaneous lesion demonstrated uniform neoplastic cells arranged in a trabecular pattern extending from the dermis to subcutis. Mitotic figures were abundant. Although the overlying epidermis was substantially intact, the Merkel cells had invaded the epidermis, resulting in Pautrier-like microabscesses. The hyperplastic epidermis adjacent to the nodule consisted of abnormally growing atypical keratinocytes. The enlarged left inguinal lymph node and successive secondary nodules contained Merkel cells similar to those in the primary nodule. Immunohistochemically, most tumor cells were positive for CAM5.2, synaptophysin, chromogranin A, CD56 and vimentin. The tumor cells in the left inguinal lymph node were positive for CAM5.2, synaptophysin and cytokeratin 20 but negative for CM2B4, and less than 1% of the cells expressed programmed cell death ligand 1. The patient was treated with avelumab, which showed significant efficacy against the in-transit recurrence. Two months later, all nodules had disappeared completely. We describe a case of in-transit recurrence of Merkel cell carcinoma that was associated histologically with Bowen's disease and was successfully treated with avelumab. Although accumulation of additional cases is needed, avelumab therapy may be a useful treatment for in-transit recurrence of Merkel cell carcinoma.
Asunto(s)
Anticuerpos Monoclonales/administración & dosificación , Enfermedad de Bowen/terapia , Carcinoma de Células de Merkel/terapia , Recurrencia Local de Neoplasia/tratamiento farmacológico , Neoplasias Cutáneas/terapia , Anciano , Anticuerpos Monoclonales Humanizados , Enfermedad de Bowen/patología , Carcinoma de Células de Merkel/patología , Procedimientos Quirúrgicos Dermatologicos , Esquema de Medicación , Humanos , Infusiones Intravenosas , Pierna , Masculino , Piel/patología , Neoplasias Cutáneas/patología , Resultado del TratamientoAsunto(s)
Ácido Aminolevulínico/análogos & derivados , Dolor Asociado a Procedimientos Médicos/diagnóstico , Fotoquimioterapia/efectos adversos , Fármacos Fotosensibilizantes/efectos adversos , Administración Cutánea , Adulto , Anciano , Anciano de 80 o más Años , Ácido Aminolevulínico/administración & dosificación , Ácido Aminolevulínico/efectos adversos , Enfermedad de Bowen/terapia , Carcinoma Basocelular/terapia , Femenino , Fluorescencia , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Dolor Asociado a Procedimientos Médicos/etiología , Fotoquimioterapia/métodos , Fármacos Fotosensibilizantes/administración & dosificación , Estudios Retrospectivos , Factores Sexuales , Neoplasias Cutáneas/terapia , Resultado del TratamientoRESUMEN
A 53-year-old white woman presented to our clinic with skin lesions in the anogenital region that had persisted for 1 year. She had a past medical history of total vulvectomy for a vulvar localization of Bowen's disease. She was otherwise in good health, with no evidence of illness or immunosuppression. Physical examination revealed multiple erythematous papular lesions located in the anogenital region (Figure 1). Dermatoscopy of the anogenital papules revealed glomerular vessels on an erythematous background typical of Bowen's disease (Figure 2A). There were no palpable inguinal lymph nodes. Rectosigmoidoscopy was normal. The biopsy specimen showed full thickness keratinocyte atypia with loss of normal stratification and was conclusive for Bowen's disease (Figure 2B).
Asunto(s)
Antineoplásicos/uso terapéutico , Enfermedad de Bowen/terapia , Imiquimod/uso terapéutico , Terapia por Láser , Láseres de Gas/uso terapéutico , Neoplasias Cutáneas/terapia , Enfermedad de Bowen/patología , Terapia Combinada , Femenino , Humanos , Persona de Mediana Edad , Neoplasias Cutáneas/patologíaRESUMEN
INTRODUCTION: Penile intra-epithelial neoplasia (PIN) are precancerous lesions, characterized by architectural and cytological abnormalities of the genital epithelium, from which can arise squamous carcinomas. METHODS: A literature review was performed on the Medline database, considering the articles listed between October 2007 and October 2017 dealing with PIN, using the following keywords "intraepithelial neoplasia" or "Bowen's disease" or "erythroplasia of Queyrat" or "bowenoid papulosis" and "penis ¼. Papers were selected according to their language (English and French) and their relevance. RESULTS: One hundred seventy four articles related to PIN were listed. Twenty-five of them were selected for their relevance. The analysis of the references of these articles identified 6 relevant papers published before October 2007, which were considered for this review based on a total of thirty-one articles. We describe clinical and pathological characteristics of PIN, emphasizing treatment modalities. CONCLUSION: Urologists should distinguish HPV-related and non HPV-related PIN, both of them sharing clinical presentation, but needing different management.
Asunto(s)
Enfermedad de Bowen/diagnóstico , Carcinoma in Situ/diagnóstico , Neoplasias del Pene/diagnóstico , Enfermedad de Bowen/patología , Enfermedad de Bowen/terapia , Carcinoma in Situ/patología , Carcinoma in Situ/terapia , Humanos , Masculino , Infecciones por Papillomavirus/complicaciones , Neoplasias del Pene/patología , Neoplasias del Pene/terapia , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/terapiaRESUMEN
BACKGROUND: Ablative fractional laser (AFL)-assisted methyl aminolevulinate (MAL) photodynamic therapy (PDT) (AFL-MAL-PDT) has shown significantly higher efficacy and lower recurrence rates at 12 months than conventional methyl aminolevulinate photodynamic therapy (MAL-PDT) for the treatment of Bowen disease (BD). However, long-term follow-up data are not available. OBJECTIVE: To compare the 5-year efficacy and recurrence rates of AFL-MAL-PDT with those of conventional MAL-PDT for the treatment of lower extremity BD. METHODS: A total of 60 patients with 84 BD lesions were randomly assigned to a single session of AFL-MAL-PDT or 2 sessions of MAL-PDT with a 1-week interval between sessions. Patients were followed up at 3, 12, 24, 36, 48, and 60 months after treatment. Efficacy, recurrence rates, and risk factors for unsuccessful treatments were assessed. RESULTS: After 5 years, the overall clearance rate of AFL-MAL-PDT (84.78%) was significantly better than that of MAL-PDT (44.74%) for BD lesions. The recurrence rate was significantly lower for AFL-MAL-PDT (9.3%) than for MAL-PDT (41.38%). Diameters larger than 20 mm and lesions with a history of previous treatment were independent factors for treatment failure. LIMITATIONS: The small sample size and single-center study design were limitations. CONCLUSIONS: For patients with lower extremity BD lesions, AFL-MAL-PDT showed significantly higher long-term efficacy and lower recurrence rates than standard MAL-PDT.
Asunto(s)
Ácido Aminolevulínico/análogos & derivados , Enfermedad de Bowen/terapia , Terapia por Láser/métodos , Recurrencia Local de Neoplasia/patología , Fotoquimioterapia/métodos , Neoplasias Cutáneas/terapia , Anciano , Anciano de 80 o más Años , Ácido Aminolevulínico/administración & dosificación , Biopsia con Aguja , Enfermedad de Bowen/mortalidad , Enfermedad de Bowen/patología , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Inmunohistoquímica , Extremidad Inferior , Masculino , Persona de Mediana Edad , Cirugía de Mohs/métodos , Recurrencia Local de Neoplasia/epidemiología , Recurrencia Local de Neoplasia/fisiopatología , Neoplasias Cutáneas/mortalidad , Neoplasias Cutáneas/patología , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Laser-assisted photodynamic therapy is being explored as a method to enhance efficacy of photodynamic therapy (PDT). OBJECTIVE: To compare a continuous (CL) and a fractional (FL) ablative CO2 laser-assisted methyl aminolevulinate (MAL) PDT in the management of superficial basal cell carcinoma (sBCC) and Bowen's disease (BD). METHODS: Thirty treatment areas in fifteen patients with inoperable, histologically verified sBCC or BD received CL or FL after intrapatient randomization. Laser treatment was followed by MAL application and illumination occurred 3 h later. This treatment was repeated after 2 weeks. An equivalence analysis was performed on the primary endpoint efficacy, while secondary endpoints pain, side-effects and aesthetics were evaluated using paired samples tests. Patients were also asked for their preferred treatment. RESULTS: An excellent efficacy of 92.9% (sBCC, 100%; BD, 80%) was found in both CL + PDT and FL + PDT after 12 months. Equivalence could not be established. Little pain was perceived in most patients during PDT illumination. PDT treatment in FL + PDT was less painful, significantly during the second treatment (P = 0.026). Side-effects were mild to moderate with erythema being the most frequent immediate side-effect, followed by oedema, crusting and burning sensation. Pigmentary changes occurred in 21% (CL + PDT) to 29% (FL + PDT), and aesthetics were good to excellent in all patients. CL + PDT and FL + PDT did not significantly differ in side-effects (P = 0.219-1.000) or aesthetics (P = 0.157-1.000). CONCLUSIONS: Results in this pilot study support the promising role of laser-assisted PDT. Both treatment arms demonstrated the same efficacy as well as comparable side-effects and aesthetics. PDT illumination was significantly less painful in the FL + PDT group, suggesting a preference for FL + PDT. The authors recommend further investigation with a larger sample size, a subgroup analysis between sBCC and BD and comparison of different treatment protocols before one technique could be preferred to another.