10.5826/dpc.1304a261
text/xml
2160-9381
3225
en
Ifa Etesami
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Skin cancer
Clinicopathological Characteristics of Bowen Disease: A 7-year Study at a Referral Dermatology Hospital
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2023-10-31
2023-02-06
2023-10-31
2024-01-16
e2023261
Dermatol Pract Concept
Ifa Etesami
2023/10/31
10.5826/dpc.1304a261
e2023261
Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
2160-9381
Skin cancer
en
e2023261
Palaniappan V, Karthikeyan K. Bowen’s Disease. Indian Dermatol Online J. 2022;13(2):177-189. DOI: 10.4103/idoj.idoj_257_21. PMID: 35287414. PMCID: PMC8917478
Clinicopathological Characteristics of Bowen Disease: A 7-year Study at a Referral Dermatology Hospital
https://dpcj.org/index.php/dpc/article/download/3225/2386
     Clinicopathological Characteristics of Bowen
  Disease: A 7-Year Study at a Referral Dermatology
                       Hospital
  Seyed Mohammad Vahabi1, Mohammad Sadegh Dehghan Nasiri1, Farzad Esmaeili Tarki2,
            Hamidreza Mahmoudi3, Maryam Daneshpazhooh3, Ifa Etesami3


1 Tehran University of Medical Sciences, Tehran, Iran
2 Research Institute of Internal Medicine, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran



Key words: Bowen disease, Squamous cell carcinoma, SCC in situ, Skin cancer
Citation: Vahabi SM, Dehghan Nasiri MS, Esmaeili Tarki F, Mahmoudi H, Daneshpazhooh M, Etesami I. Clinicopathological
Characteristics of Bowen’s Disease: A 7-year study at a Referral dermatology Hospital. Dermatol Pract Concept. 2023;13(4):e2023261.
DOI: https://doi.org/10.5826/dpc.1304a261
Accepted: June 27, 2023; Published: October 2023
Copyright: ©2023 Vahabi et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Dr. Ifa Etesami, Assistant Professor of Dermatology, Department of Dermatology, Razi Hospital, Tehran University
of Medical Sciences, Vahdat-e- eslami square, Tehran, Iran zip code: 1199663911, Telephone: +98 912 566 5779
E-mail: ifa.etesami@gmail.com




Introduction                                                             Case Presentation
Bowen disease (BD) is an epithelial squamous cell carcinoma              A total of 211 patients were studied with a mean age of
(SCC) in situ, frequently diagnosed in the elderly with 3-5%             66.2 (± 14.4) years, 149 cases (70.6%) were male. The av-
risk of progression to SCC [1,2].                                        erage number of lesions was 1.4 ± 0.9. Among them, 9 cases
    This retrospective study was conducted at a referral                 (4.2%) had a history of arsenic toxicity, 12 cases (5.6%) had
dermatology hospital for 7 years (March 2013 until March                 a history of immunodeficiency, and 23 cases (10.9%) mani-
2020) in a Middle Eastern population to elucidate the char-              fested the pagetoid type of BD.
acteristics of BD. All patients diagnosed by histopathology                   The findings indicated that 22 cases (10.4%) had a his-
with BD were included, and data was extracted from their                 tory of BCC, and 14 cases (6.6%) with a history of SCC.
medical records.                                                         Meanwhile, 72 cases (34.1%) developed SCC on their
                                                                         Bowen lesions. The most common anatomical locations of
                                                                         lesions were head and neck, and trunk, both with an equal
                                                                         incidence of 30.8% (65 cases). Followed by lower limbs
                                                                         26.5%, upper limbs 24.2%, and genitalia 1.4%.




Research Letter | Dermatol Pract Concept. 2023;13(4):e2023261                                                                         1
Figure 1. A full-thickness atypia of the epidermis which also shows           Figure 2. This high-power view shows complete loss of maturation;
multiple dyskeratotic cells, acanthosis and overlying parakeratosis           suprabasal mitosis is present (×400).
(×200).


      Associated actinic keratosis (Figures 1 and 2) was re-                       Recurrence was reported in 9 (4.2%) cases with a mean
ported in 48 cases (22.7%), Seborrheic keratosis in 5 cases                   time of 5.12 ± 1.38 years.
(2.4%), and epidermodysplasia verruciformis in 15 cases                            Only 12 patients had dermoscopic images taken by foto-
(7.1%). Granulation and ulcerations upon the lesions                          finder systems based on their data records and were assessed
were observed in 0.9% and 7.1% of patients, respectively.                     by two dermatologists. Dermoscopic findings were as fol-
­Lichenoid reaction as the only dermal alterations in the le-                 lows; white scaling in 11 patients (91.67%), yellow scaling
sions were recorded in 5 cases (2.4%). As for the different                   in 9 patients (75%) and then clustered glomerular vessels in
epidermal changes, psoriasiform hyperplasia, melanin pig-                     8 patients (66.67%).
mentation, clear cell, and epidermolytic hypergranolosis                           Table 1 shows there is a statistically meaningful as-
were reported in 4.7%, 2.4%, 1.4%, and 0.9% of patients,                      sociation between sex and the anatomic site of lesions
respectively.                                                                 (P < 0.05). BD was more significantly observed on men head
                                                                              and neck (38.1%) while women had BD mainly on their


Table 1. Association analysis of correlation between different clinical features (the percentages are
indicative of the portion of lesion sites in each gender).
                                                                    Anatomic Site of Lesions
                                                    Face and                                                 Upper       Lower
                                      Scalp            Ear           Neck         Trunk      Genitalia       Limbs       Limbs          P
    Sex           Male            19 (12.7%)           33             5              43           2            30           40        0.002*
                                                    (22.1%)        (3.3%)         (28.8%)      (1.3%)       (20.1%)      (26.8%)
                  Female                1               6             1              22           1            21           16
                                     (1.6%)          (9.7%)        (1.6%)         (35.5%)      (1.6%)       (33.9%)      (25.8%)
    SCC on        With SCC              5              12             3              18           3            20           23        0.187
    Bowen                            (6.9%)         (16.7%)        (4.2%)         (25.0%)      (4.2%)       (27.8%)      (31.9%)
    Disease       Without         15 (10.8%)           27             3              47           0            31           33
                  SCC                               (19.4%)        (2.2%)         (33.8%)       (0%)        (22.3%)      (23.7%)
SCC = squamous cell carcinoma.
a
    P -values smaller than 0.05 which is indicative of statistical significance




2                                                                                  Research Letter | Dermatol Pract Concept. 2023;13(4):e2023261
trunk (35.5%). SCC development has no significant associ-        recurrence rate of BD was less than 5 % and also risk of SCC
ation with anatomic site of lesions (P = 0.186) or with sex      development on BD lesions were near 35% in this study.
(P = 0.960).

                                                                 References
Conclusions                                                      1. Morton CA, Birnie AJ, Eedy DJ. British Association of Derma-
                                                                    tologists’ guidelines for the management of squamous cell carci-
The results revealed a significantly higher prevalence of BD
                                                                    noma in situ (Bowen’s disease) 2014. Br J Dermatol. 2014;170(2):
in men in sun-exposed areas. While women, despite having a
                                                                    245-260. DOI: 10.1111/bjd.12766. PMID: 24313974.
lower incidence of the disease, the lesions were significantly   2. Palaniappan V, Karthikeyan K. Bowen’s Disease. Indian Der-
less common in the head and covered areas of the face. This         matol Online J. 2022;13(2):177-189. DOI: 10.4103/idoj
difference can be explained of wearing hijab in our country         .idoj_257_21. PMID: 35287414. PMCID: PMC8917478.
by women that protects the scalp and some areas of their
faces such as ears. This study highlights the impact of geo-
graphic, cultural and ethnic issues in BD characteristics. The




Research Letter | Dermatol Pract Concept. 2023;13(4):e2023261                                                                     3
