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 Table of Contents  
LETTER TO EDITOR
Year : 2019  |  Volume : 6  |  Issue : 2  |  Page : 115-116

Retroauricular bowen's disease of skin in an elderly female


1 Department of Pathology, ANIIMS, Port Blair, Andaman and Nicobar, India
2 Department of Dermatology, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India

Date of Web Publication28-Nov-2019

Correspondence Address:
Pradeep Balasubramanian
Department of Dermatology, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijdpdd.ijdpdd_21_19

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How to cite this article:
Garg P, Balasubramanian P. Retroauricular bowen's disease of skin in an elderly female. Indian J Dermatopathol Diagn Dermatol 2019;6:115-6

How to cite this URL:
Garg P, Balasubramanian P. Retroauricular bowen's disease of skin in an elderly female. Indian J Dermatopathol Diagn Dermatol [serial online] 2019 [cited 2020 Jun 1];6:115-6. Available from: http://www.ijdpdd.com/text.asp?2019/6/2/115/271938



Sir,

Bowen's disease is an intraepidermal squamous cell carcinoma (SCC), also termed as carcinoma in situ. It usually occurs in 6th–8th decades of life, predominantly in the head-and-neck area.[1] It presents as well-defined gradually progressing erythematous patches or plaques with scaly or crusted surface.[2] Early diagnosis and treatment are required as it has the risk of progression to invasive SCC. We herewith report a case of retroauricular Bowen's disease considering the rarity of the site being involved and to depict the successful therapeutic response to 5-fluorouracil (5-FU) cream.

A 65-year-old female presented to skin outpatient department with painless, gradually progressive erythematous plaque with violaceous hue in retroauricular area on the right side for 2 years' duration. There was no history of trauma, exposure to radiations, or chemical agents. No significant medical history was observed. On examination, the patient had a well-defined erythematous plaque of 4 cm × 3 cm in size with irregular margins in the retroauricular area. Surface was scaly and crusted [Figure 1]. No regional lymph nodes were palpable. Incisional biopsy was done under local anesthesia.
Figure 1: Erythematous plaque in retroauricular region

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On histopathological examination, the epidermis showed acanthosis and thickening of rete ridges with disorderly arranged atypical squamous epithelial cells throughout the epidermis, depicting a “wind-blown” appearance. At places, dyskeratotic cells with few atypical mitotic figures were seen. The dyskeratotic cells were large, round with dense eosinophilic cytoplasm and hyperchromatic nuclei. Superficial dermis showed chronic inflammatory cells and dyskeratotic cells in the follicular region. There was no evidence of dermal invasion seen. The histological features were consistent with Bowen's disease [Figure 2] and [Figure 3]. The patient was started on topical 5-FU cream. One month following the initiation of the 5-FU cream, the lesion completely subsided [Figure 4].
Figure 2: The disorderly arranged keratinocytes depicting “wind-blown” appearance (H and E, ×100)

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Figure 3: Dyskeratotic cells seen throughout the epidermis (H and E, ×40)

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Figure 4: Complete resolution of plaque following the application of 5-fluorouracil cream

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Bowen's disease is also termed as intraepithelial or in situ SCC. It was first described by John T Bowen in 1912. It usually affects sun-exposed sites and flexural, perianal, subungual, and genital areas.[3] It presents as slow-growing well-demarcated plaque or patch. Several histopathologic variants include psoriasiform, atrophic, verrucous, hypertrophic, pigmented, and irregular.[3] Ulceration is the sign of invasiveness. The risk of progression to invasive SCC in extragenital lesion is 3%–5% of cases and in genital lesion is 10%.[4]

Clinical differential diagnoses are basal cell carcinoma, psoriasis, lichen planus, seborrheic keratosis, and superficial spreading melanoma. Histopathological differentials are Paget's disease, melanoma and pseudoepitheliomatous hyperplasia.[4]

Treatment modalities depend on sites, size, number of lesions, availability of therapy, and patient factors (age, immune status, and comorbidities).[3] Treatment options that have been tried with varying degree of success include topical chemotherapy with 5-FU, excision, Moh's micrographic surgery, electrodessication, photodynamic therapy, curettage, cryotherapy, carbon dioxide laser therapy, radiotherapy, and 5%imiquimod therapy.[1]

We report this case considering the rarity of the site involved and to reinforce the therapeutic efficacy of topical 5-FU in Bowen's disease though it might be associated with inflammatory features in some individuals.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kossard S, Rosen R. Cutaneous Bowen's disease. An analysis of 1001 cases according to age, sex, and site. J Am Acad Dermatol 1992;27:406-10.  Back to cited text no. 1
    
2.
Dandale A, Mantri MD, Thakkar V, Dhurat RS, Ghate S. Bowen's disease: An unusual clinical presentation. Indian Dermatol Online J 2014;5:526-8.  Back to cited text no. 2
  [Full text]  
3.
Nagakeerthana S, Rajesh G, Madhavi S, Karthikeyan K. Bowen's disease: Two case reports of a giant and dwarf lesions. J Cancer Res Ther 2017;13:371-3.  Back to cited text no. 3
    
4.
Gawkrodger DJ, Ormerod AD, Shaw L, Mauri-Sole I, Whitton ME, Watts MJ, et al. Guideline for the diagnosis and management of vitiligo. Br J Dermatol 2008;159:1051-76.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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