Human papillomavirus 16-related Bowen’s disease on nail apparatus

( Dae Young Oh ),( Ji Seon Kim ),( Hyun Yi Lee ),( Yu Jin Jeon ),( Dae Won Koo ),( Joong Sun Lee ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1

Bowen’s disease is a common cutaneous malignancy, regardless of race. Various causes of Bowen’s disease include solar damage, arsenic, immunosuppression and viral infection. A 15-year-old woman presented with mild tender, verrucous plaque involving proximal to lateral nail fold of both great finger of 4 years in duration. The lesion began to increase in size 1 year ago. Histopathologic examination of the lesion on the nail fold revealed mild to moderate dysplasia of squamous epithelium with perinuclear haloes; suggesting Bowen’s disease related to viral infection. HPV 16 positivity appeared in the HPV PCR test. Skin lesion was gradually improved with 2 times of cryosurgery and HPV vaccine injection (Gardasil®). HPV 16 has been known as a mucosal oncogenic HPV, and the virus is regarded as a high-risk factor in the development of cervical cancer. A few cases of HPV 16-related Bowen’s disease on the hand and were reported. However, only 3 cases of HPV 16-related Bowen’s disease on nail apparatus were reported. Bowen’s disease of the nail apparatus differs from that of the skin. Unfortunately, carcinogenic role of HPV 16 in human cutaneous keratinocyte has yet to be elucidated. Thus, although it is rare, dermatologists should be aware that HPV 16-related Bowen’s disease may occur on the periungal area with favorable outcome with cryosurgery and HPV vaccine and perform biopsy with HPV PCR to evaluate other suspected diseases.

보웬병의 임상 및 병리조직학적 연구

최희봉 ( Hee Bong Choi ),조옥자 ( Ok Ja Joh ),박시룡 ( See Ryoug Park ),김낙인 ( Nack In Kim ) 대한피부과학회 2006 대한피부과학회지 Vol.44 No.9

Background: Bowen`s disease, also known as squamous intraepidermal carcinoma, is a pre-malignant skin tumor with a potential to progress to an invasive carcinoma. Objective: The purpose of this study was to investigate the clinical and histopathological characteristics of Bowen`s disease. Methods: A total of 45 patients with Bowen`s disease were enrolled in this study. The hospital charts and histopathological slides from 1994 to 2005 were reviewed retrospectively at Seoul Veterans Hospital. Results: There were thirty-seven cases (82%) of single lesions and eight cases (18%) of multiple lesions. Thirty cases (81%) of solitary Bowen`s disease were located in non sun-exposed areas. These included the trunk, extremities and genital area in decreasing order. Seven cases (19%) of solitary Bowen`s disease occurred on sun-exposed areas including the face and the dorsum of the hand in decreasing order. Analysis of the clinical character of Bowen`s disease was performed and results were as follows: the most common type was patch (20 cases; 44%), plaque (14 cases; 31%) and pigmented lesions (12 cases: 27%). Analysis of the histopathological character of Bowen`s disease was performed and results were as follows: the most common type was irregular (18 cases; 46%), psoriasiform (11 cases; 28%) and verrucous, atrophic type in decreasing order. Of 18 cases where surgical removal was performed, there were 2 case (11%) of recurrence. Of 16 cases where cryotherapy treatment was administered, there were 3 cases of recurrence. And of 4 cases where CO2 laser therapy was used, there was 1 case (25%) of recurrence, in 2 cases where multiple or large-sized lesions were observed, clinical recovery processes were monitored after applying isotretinoin and 5-FU combined therapy, as well as surgical removal and cryotherapy combined therapy. Conclusion: In Bowen`s disease among Koreans, there were many distinctive clinical and histopathological features compared to those of non-Korean cases. (Korean J Dermatol 2006;44(9):1058~1064)

P065 Clinical efficacy of ingenol mebutate gel for Bowen`s disease

( Jae Won Ha ),( Ji Eun Hahm ),( So Eun Park ),( Jin Yong Lee ),( Chul Woo Kim ),( Sang Seok Kim ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.2

<div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div> Background: Bowen’s disease represents a form of squamous cell carcinoma in situ. Ingenol mebutate is a novel agent extracted from the Euphorbia peplus, which is known to have therapeutic effects on skin cancerous lesions. Objectives: We tried to estimate the efficacy of ingenol mebutate to Bowen’s disease (7cases) and observed the therapeutic results and recurrence of the Bowen’s disease. Methods: In our study, Enrolled Patients usually presented erythematous plaques or erythematous scaly patches and diagnosed with Bowen’s disease by skin punch biopsy. We applied ingenol mebutate 0.015% gel 3 consecutive days for patient with facial lesions and ingenol mebutate 0.05% gel 2 consecutive days for lesions of trunk or extremities. And we checked paitents regularly for the therapeutic effect of treatment and recurrence of Bowen’s disease. Results: In almost cases (5cases), after the treatment, the lesions seem to be completely resolved and there were no abnormal pathologic signs until 8~30 weeks. But In 2 cases, recurrence of Bowen’s disease are confirmed by clinical and histopathological findings (24weeks, 40weeks). Conclusion: Even though ingenol mebutate is one of the best treatment options for treating precancerous lesions like actinic keratosis, there are some limitations as recurrence for Bowen’s disease. For estimate the efficacy of ingenol mebutate in Bowen’s disease, long term follow up should be required.

Limited clinical efficacy of ingenol mebutate for Bowen`s disease

( Jae Won Ha ),( Ji Eun Hahm ),( So Eun Park ),( Jin Yong Lee ),( Chul Woo Kim ),( Sang Seok Kim ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

Bowen’s disease represents a form of squamous cell carcinoma in situ. Ingenol mebutate is a novel agent which is known to have therapeutic effects on skin cancerous lesions. We report two cases of Bowen’s disease treated with ingenol mebutate, but recurred on the long term follow up. Case 1: A 82-year-old woman visited to our clinic with walnut sized annular erythemaotus plaque on her right ankle. Skin biopsy was done and the patient was diagnosed with Bowen’s disease. We applied ingenol mebutate 0.05% gel 2 consecutive days once daily. Until 12weeks after the treatment, the lesion was clinically resolved. But 24 weeks after the treatment, the site showed erythematous patch and on the follow up biopsy, the examination showed recurrence of Bowen’s disease. Case 2: A 57-year-old woman was diagnosed as Bowen’s disease on the right flank. We applied ingenol mebutate 0.05% gel on the affected area for 2 consecutive days once daily. 12weeks after the treatment, the lesion was clinically resolved. But 40 weeks after the treatment, the lesion showed brownish patch and follow up biopsy was done. The histopathologic findings was consistent with Bowen’s disease. In our cases we applied ingenol mebutate gel for treatment of Bowen’s disease. After the treatment, the lesions seem to be completely resolved and there were no abnormal pathologic signs. But after 6month follow up biopsy showed recurrence of Bowen’s disease in both cases.

Focal CK7 positivity in Pagetoid Bowen’s disease: a mimic of extramammary Paget’s disease

( Jae-ho Lee ),( Ho-young Kim ),( Joong-heon Suh ),( Soo-kyung Lee ),( Myoung-shin Kim ),( Un-ha Lee ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1

Bowen’s disease is a variant of squamous cell carcinoma in situ, usually presented as solitary scaly and crusted erythematous patches with irregular outline. Bowen’s disease has predilection for sun exposed regions in patients 60 years of age or older. About 5% of cases, a pagetoid growth pattern can be observed with cytologically atypical clear cells arranged singly and in nests. The differential diagnosis of pagetoid Bowen’s disease includes extramammary Paget’s disease (EMPD) and malignant melanoma in situ, as well as other less common entities. Cytokeratin (CK) 7 staining can be a useful tool to make this clear, usually positive for EMPD but negative for Bowen’s disease. A 85-year-old woman presented with erythematous scaly patch on her left cheek. Biopsy specimen showed full epidermal thickness atypical keratinocytes and nests of pagetoid cells with pale eosinophilic cytoplasm in epidermis. The atypical cells were positive using CK7 and negative for HER2 (CerbB2), HMB-45 and Melan-A. Given the biopsy reports of EMPD, an additional panel of immunohistochemistry was performed. The neoplastic cells were positive for p63 and negative for CK20 and Mucicarmine. On the basis of these findings, we established the diagnosis of pagetoid Bowen’s disease. Thus, we report a case of pagetoid Bowen’s disease exhibiting focal staining with CK7, this unusual and unexpected immunophenotype resulting in misdiagnosis as EMPD.

A case of pigmented Bowen’s disease on the neck

( In-hye Kang ),( Ye-jin Lee ),( Jong-kil Seo ),( Hye-jin Ahn ),( Min Kyung Shin ),( Mu-hyoung Lee ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

Pigmented Bowen’s disease is a rare pigmented variant of Bowen’s disease, with a higher prevalence in men and blacks aged 60-70 years. It presents clinically as a well-demarcated plaque, pigmented, flat and asymptomatic, in areas unexposed to the sun. It is characterized by increased melanin pigment in the epidermis or papillary dermis, in addition to the typical findings of Bowen’s disease. This disorder has been infrequently reported and it accounts for less than 2% of all cases of Bowen’s disease. A 49-year-old male presented with a 2-year history of intermittent painful lesion on the neck. Physical examination revealed a solitary, scaly, black colored plaque on the right neck measuring 1x1cm in size. The histopathologic findings showed hyperkeratosis, parakeratosis and atypical keratinocytes disorderly arranged throughout the epidermis. Increased melanin pigment was noted in the basal layer of the epidermis and papillary dermis. From these findings, it was diagnosed as pigmented Bowen’s disease. We herein report a pigmented Bowen’s disease, which is a rare variant of Bowen’s disease.

Bowen`s disease originated from verruca

( Eun Sun Kwon ),( Byoung Yong Koh ),( Ki Bum Myung ),( Seung ),( Hyun Cheong ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Bowen’s disease is a precancerous condition that has the potential to progress to squamous cell carcinoma. The human papillomavirus(HPV) infection is associated with bowen’s disease. And recently HPV DNA has been detected to up to 30% on the extragenital bowen’s disease lesions. A 49-year-old woman presented solitary erythematous plaque with verrucous central region on the right calf. At first the lesion was just small verrucous papule, but gradually enlarged and became erythematous. The biopsy specimen from verrucous central region showed hyperkeratosis, parakeratotic tier within the stratum corneum, acanthosis and papillomatosis with inward bending of rete ridges. These findings were appropriate for verruca. But the specimen also revealed the features of bowen’s disease. Numerous atypical and pleomorphic cells showed mitotic figures and loss of polarity throughout stratum malpighi. The upper dermis was infiltrated by inflammatory cells. And specimen was stained weakly positive for p53 and strongly positive for p16 and Ki-67. Based on the clinical and histopathologic findings, the skin lesion simultaneously had the features of bowen’s disease and verruca. Therefore we suggest that the bowen’s disease may resulted from verruca and be associated with HPV infection. Here, we present a case of bowen’s disease originated from verruca.

Morphometric assessment of nuclei in Bowen's disease and bowenoid papulosis

Yu, Dong-Soo,Kim, Gina,Song, Hae-Jun,Oh, Chil-Hwan Munksgaard International Publishers 2004 SKIN RESEARCH AND TECHNOLOGY Vol.10 No.1

<P>Background: </P><p>Occasionally, Bowen's disease and bowenoid papulosis cannot be distinguished in microscopic finding. Their clinical presentations are quite different from one another. The purpose of this study was to evaluate the histological differences in Bowen's disease and bowenoid papulosis, by comparing the size and shape of nuclei, using image analysis system.</p><P>Methods: </P><p>We performed morphometric assessment on 13 specimens of Bowen's disease and eight specimens of bowenoid papulosis using an image analysis system, and the following parameters were calculated, such as nuclear contour index (NCI), irregularities of nucleus (IN), form factor (form AR) and circulatory factor (form PE).</p><P>Results: </P><p>For NCI, there were significant differences between the Bowen's disease and bowenoid papulosis, and IN also shows significant differences between these two dis-eases, showing that Bowen's disease has more corrugated or indented nucleus contour than bowenoid papulosis. In the parameter of form PE, there were significant differences between the two diseases, indicating that Bowen's disease has more oval-shaped nuclei than bowenoid papulosis. There were no significant differences in form factor between Bowen's disease and bowenoid pupulosis.</p><P>Conclusions: </P><p>Significant differences were found in the morphometric evaluation between Bowen's disease and bowenoid papulosis. The nuclei were larger, more oval and more irregular margins in Bowen's disease than bowenoid papulosis.</p>

Vulvar Bowen`s disease: the importance of dermatologic diagnosis

( Hee Chul Chung ),( Sung Jay Choe ),( Won Soo Lee ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

A 62-year-old female presented a well-demarcatederythematous painful patch with mild erosion on the vulva and perineum for 3 years. Although she had been treated by antifungal and antiviral therapy for several years at local gynecologic and urologic clinics, lesions were not improved. Histopathologically, the specimen revealed full-thickness epidermal proliferation with disorder and wind-blown appearance, while the dermis remained intact. Human papilloma virus type 16 was detected on the lesion. Along with above findings, diagnosis of vulva Bowen’s disease was established, followed by total excision of the lesion. Bowen’s disease on the vulvar area, so called vulvar intraepithelial neoplasia, could occasionally show atypical presentations such as erosion, ulceration and hyperpigmentation. In addition, not so much cases of vulva Bowen’s disease were reported, considering there have been only four cases of female genital Bowen’s disease in department of dermatology of our hospital from 2001 to 2014. However, dermatologists should pay more attention to the genital skin disease such as vulva Bowen’s disease than other physcians. Therefore, we recommend that the biopsy should be taken into consideration when atypical genital lesions were encountered, because many cases of vulvar Bowen’s disease would be undiscovered unexpectedly.

Case Report : A Case of Pigmented Bowen`s Disease

Jung Woo Lee,Jae Hur,Kwang Yeoll Yeo,Hee Joon Yu,Joung Soo Kim 대한피부과학회 2009 Annals of Dermatology Vol.21 No.2

Pigmented Bowen`s disease is characterized by increased melanin pigment in the epidermis or papillary dermis, in addition to the typical findings of Bowen`s disease. This disorder has been infrequently reported and it represents less than 2% of all cases of Bowen`s disease. Thus far, there has been only 1 case of pigmented Bowen`s disease on the umbilicus in the medical literature, and no such case has been reported in Korea. Pigmented Bowen`s disease develops on sun-exposed areas of the face and neck, as well as sun-un-exposed areas like the trunk, extremities, perianal area and umbilcus. A 36-year-old man presented with a 9-month history of solitary dark brown slithery or wavy plaque with a verrucous surface on the umbilicus, and the lesion measured 1x2 cm in size. The histopathologic findings showed hyperkeratosis, parakeratosis and atypical keratinocytes disorderly arranged throughout the epidermis. Increased melanin pigment was noted in the basal layer of the epidermis. From these findings, we diagnosed this lesion as pigmented Bowen`s disease. (Ann Dermatol 21(2) 197~199, 2009)