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Patient assessment
Published in Michael Parker, Charlie James, Fundamentals for Cosmetic Practice, 2022
Unlike solar keratoses, Bowen’s disease is a premalignant tumour which arises from dysplastic changes throughout the entire epidermis. It is likely that as they have a greater number of epidermal layers involved, they are more susceptible to becoming malignant, with up to 5% of these premalignant tumours undergoing malignant transformation into squamous cell carcinomas. As is the case with solar keratoses, one of the key determinants in the development of Bowen’s disease is excessive sun exposure with them frequently presenting on sun-exposed areas.
Surgery of some common nail tumors
Published in Robert Baran, Dimitris Rigopoulos, Chander Grover, Eckart Haneke, Nail Therapies, 2021
Erythronychia describes a red nail, in most cases as a longitudinal red line under or in the nail, more rarely red spots or a red lunula. The latter are mainly inflammatory or vascular in origin, whereas the former are due to a variety of other causes, such as lichen planus (Figure 21.9). Multiple red lines may be isolated or seen in dyskeratosis follicularis of Darier or in keratosis cristarum. Erythronychia is sometimes associated with onychopapilloma (Figure 21.10). The latter and subungual Bowen’s disease (see below) are single lesions and of epithelial origin, whereas the red streak distal to a glomus tumor is thought to be vascular. Onychopapilloma is best excised in a longitudinal tangential way (see above Chapter Biopsy). This may be done after cautious nail plate avulsion or include the overlying nail. It is important to note that the onychopapilloma stretches from the mid-matrix to the hyponychium and that the tangential excision must not be too superficial as this is associated with a higher recurrence rate (Haneke 2017, 2011). Bowen’s disease requires a diagnostic biopsy for diagnosis and subsequent adequate therapy, best by microscopically controlled surgery (Perruchoud et al. 2016). The biopsy techniques for multiple red lines and erythematous spots depend on their localization and size (see above).
Malignant diseases of the skin
Published in Rashmi Sarkar, Anupam Das, Sumit Sethi, Concise Dermatology, 2021
Anupam Das, Yasmeen Jabeen Bhat
Treatment: Bowen’s disease may be treated with local destruction by curettage, cautery, and cryotherapy, with topical agents such as 5-fluorouracil or imiquimod, or with photodynamic therapy. Surgical excision should be done in lesions where invasion cannot be excluded by biopsy.
A retrospective study comparing different injection approaches of 5-aminolevulinic acid in patients with non-melanoma skin cancer
Published in Journal of Dermatological Treatment, 2022
Weihong Zhao, Jun Wang, Ying Zhang, Baoyong Zheng
Younger age, superficial basal cell carcinoma, and Bowen’s disease were associated with no or partial treatment response or recurrence. The results of the study agreed with the results of a retrospective cohort studies (6,16), and prospective study (11) but not agreed with a retrospective study (17), and prospective studies (1,9). The possible reasons for such controversies are the use of the different treatment therapy and/or absence of a universal algorithm for assessment for no or partial response of treatment and non-melanoma skin cancer recurrence (18). Also, the maximum penetration depth for irradiation is 3 mm only (1). The plum-blossom needle can reach 3 mm11 and needle-free injection penetrates the epidermis and delivers 5-aminolevulinic acid intradermally (10). Bowen’s disease has a risk of invasive carcinoma (6). Aggressive growth of superficial basal cell carcinoma is frequently noted in younger patients in which there is an absence of retraction artifact (19). The skin of aged patients is more susceptible to penetrate 5-aminolevulinic acid than younger patients (6). Intralesional 5-aminolevulinic acid followed by irradiation with red light is effective for non-melanoma skin cancer patients of advanced age, squamous cell carcinoma, and Paget’s disease. Also, younger patients and patients with basal cell carcinoma and Bowen’s disease require comprehensive follow-up.
Safety profile of baricitinib in Japanese patients with active rheumatoid arthritis with over 1.6 years median time in treatment: An integrated analysis of Phases 2 and 3 trials
Published in Modern Rheumatology, 2020
Masayoshi Harigai, Tsutomu Takeuchi, Josef S. Smolen, Kevin L. Winthrop, Atsushi Nishikawa, Terence P. Rooney, Chadi G. Saifan, Maher Issa, Yoshitaka Isaka, Naotsugu Akashi, Taeko Ishii, Yoshiya Tanaka
Malignancies: Ten malignancies (excluding non-melanoma skin cancer (NMSC)) were diagnosed in 10 patients (IR 1.1 (95%CI: 0.6, 2.1)): breast cancer (n = 2, including one case with metastasis); and one case each of cervix carcinoma, chondrosarcoma, diffuse large B-cell lymphoma, gastric mucosa-associated lymphoid tissue (MALT) B-cell lesion lymphoma, gastric cancer, malignant fibrous histiocytoma, rectal cancer, and renal cell carcinoma (Table 5). To further quantify malignancy risk, we assessed patients who were initiated and maintained on 4 mg (n = 407, 653.8 PY) in the All-bari-RA analysis set. In this All-bari-RA 4 mg sub-cohort, the malignancy (excluding NMSC) IR was 1.1. In the All-bari-RA analysis set, no lymphoma cases were reported in the control periods; two cases were reported during the LTE study (IR 0.2, Table 3). These two patients initially received placebo and were rescued to 4 mg. Lymphoma types were B-cell and gastric MALT B-cell lesion. The patient with B-cell lymphoma had background MTX treatment as a risk factor; the patient with MALT lymphoma, concomitant use of tacrolimus. The MALT lymphoma was successfully treated with H. pylori eradication alone. There were no other cases of lymphoproliferative disorder. There was one NMSC case reported (IR 0.11 (95%CI: 0.0, 0.6), Table 3). The patient developed a scab with erythema more than 20 years ago. This was treated with cryotherapy approximately 7 years before the study, however, a black scar remained and continued to grow. No change in size was noted after entry into the study. During the LTE study, biopsy revealed this to be Bowen’s disease and a tumorectomy was performed.
Lichen sclerosus of the vulva
Published in Climacteric, 2021
Bowen’s disease of the vulva, a rare type of squamous cell carcinoma in situ, commonly presents with a gradual enlargement of a well-demarcated erythematous epidermal lesion of the vulva, hyperkeratosis, pruritus and the presence of inflammation or irregular brown papules. Topical steroid ointments do not improve the condition and punch biopsy or incisional biopsy is required for a definitive diagnosis. Pathological features of Bowen’s disease include hyperkeratosis, parakeratosis, dyskeratosis, abnormal mitoses and the presence of proliferating atypical cells that do not invade the dermis with typical round-to-oval giant Bowen cells [31].