Photodynamic Therapy for Bowen's Disease of the Vulva Area

Bowen''s disease is a squamous cell carcinoma in situ and has the potential to progress to a squamous cell carcinoma. The authors treated two female patients (a 39-year-old and a 41-year-old) with Bowen''s disease in the vulva area using topical photodynamic therapy (PDT), involving the use of 5-aminolaevulinic acid and a light-emitting diode device. The light was administered at an intensity of 80 mW/cm² for a dose of 120 J/cm² biweekly for 6 cycles. The 39-year-old patient showed excellent clinical improvement, but the other patient achieved only a partial response. Even though one patient underwent a total excision 1 year later due to recurrence, both patients were satisfied with the cosmetic outcomes of this therapy and the partial improvement over time. The common side effect of PDT was a stinging sensation. PDT provides a relatively effective and useful alternative treatment for Bowen''s disease in the vulva area.     

Comparison of the Treatment Outcomes of Photodynamic Therapy and Ingenol Mebutate in Bowen's Disease: A Retrospective Observational Study

BackgroundBowen''s disease (BD) is treated by multiple treatment modalities.ObjectiveTo assess the effectiveness of photodynamic therapy (PDT) and ingenol mebutate (IMB) in treating BD and determine the factors affecting the treatment outcome.MethodsPatients with histologically confirmed BD from January 1, 2006, to December 31, 2017, were identified from the database of CHA Bundang Medical Center. Those treated with PDT or IMB were included. Patient, tumor characteristics, and treatment response data were retrospectively collected from the database.ResultsOverall, 44 and 24 BD were treated with PDT and IMB, respectively. Mean time to the first follow-up visit was 1.2 (0.5~4) months. Mean follow-up duration was 7.6 (1~36) months. The mean number of treatment sessions for PDT is 2 sessions (1~5), while that of IMB was equally 1 session. The complete response rates at the first follow-up visit were 66.7% and 53.0% and recurrence rates were 10.3% and 15.3% for PDT and IMB, respectively. However, the treatment outcome and recurrence rate between both treatment modalities were not significantly different (p=0.349 and p=0.993, respectively). In factor analysis, the complete response rate significantly decreased with older patients in IMB (p=0.012). Adverse events, occurred in 20.5% and 45.8% of patients treated with PDT and IMB, respectively.ConclusionPDT and IMB are effective noninvasive treatment modalities for BD. However, PDT is a safer treatment modality, considering its fewer adverse events. Particularly, with age being a factor that reduces IMB outcome, in older patients, PDT can be considered as preferred treatments over IMB.     

Photodynamic Therapy with Ablative Carbon Dioxide Fractional Laser for Treating Bowen Disease

Background

Topical photodynamic therapy (PDT) has been increasingly used to treat malignant skin tumors including the Bowen disease. However, patients could be displeased with the long incubation time required for conventional PDT.

Objective

We evaluated the efficacy and safety of PDT with a short incubation time of ablative CO₂ fractional laser pretreatment for treating Bowen disease.

Methods

Ten patients were included. Just before applying the topical photosensitizer, all lesions were treated with ablative CO₂ fractional laser, following the application of methyl aminolevulinate and irradiation with red light (Aktilite CL 128). Histological confirmation, rebiopsy, and clinical assessments were performed. Adverse events were also recorded.

Results

Five of the ten (50%) lesions showed a complete response (CR) within three PDT sessions. After four treatment sessions, all lesions except one penile shaft lesion (90%) achieved clinical and histological CR or clinical CR only. The average number of treatments to CR was 3.70±1.70. The treatments showed favorable cosmetic outcomes and no serious adverse events.

Conclusion

The results suggest that pretreatment with an ablative fractional CO₂ laser before PDT has similar treatment efficacy and requires a shorter photosensitizer incubation time compared with the conventional PDT method.     

Extramammary Paget's Disease of External Genitalia with Bowenoid Features

Extramammary Paget''s disease (EMPD) is an uncommon intraepithelial adenocarcinoma, primarily affecting the apocrine-bearing skin. Bowen disease is an intraepithelial squamous cell carcinoma having the potential to become invasive carcinoma. The histopathological concomitant features between EMPD and Bowen disease have been described. One theory is that primary EMPD arises multicentrically, within the epidermis from the pluripotent stem cells. Herein, we describe a case of EMPD that had bowenoid features, and review the previous cases associated with the origin of EMPD.     

Circumscribed palmoplantar hypokeratosis: report of two Brazilian cases

Circumscribed palmoplantar hypokeratosis is a recently recognized dermatosis andrarely reported. It was first described in 2002 and is characterized by localizedloss of the horny layer in the palmoplantar area. This dermatosis is clinicallypresented with a sharply circumscribed, reddish and asymptomatic plaque with slightlydepressed surface localized on the palms or the soles. The clinical differentialdiagnosis includes mainly porokeratosis and Bowen''s disease. Its pathogenesis remainsunknown, but studies have proposed a human papillomavirus induced disease or alocalized keratinization disorder in the palmoplantar area. We report herein twocases of patients with lesions clinically and microscopically compatible with thediagnosis of circumscribed palmoplantar hypokeratosis. We also present a briefliterature review of the etiopathogenic hyphoteses of this dermatosis.     

A Case of Bowen's Disease with Tissue Eosinophilia

An 85-year-old Japanese man with Bowen's disease on the left inguinal area is reported. Most of the inflammatory cells adjacent to the tumor were eosinophils. Tissue eosinophilia spontaneously improved after biopsy.     

Clinical Features of Cutaneous Premalignant Lesions in Busan City and the Eastern Gyeongnam Province,Korea: A Retrospective Review of 1,292 Cases over 19 Years (1995~2013)

BackgroundThe global prevalence of premalignant lesions has been continuously increasing in recent years, but there has been little research regarding the distribution and incidence of cutaneous premalignant lesions in Korean populations.ObjectiveWe conducted this retrospective study to analyze recent trends in the incidence and clinical patterns of cutaneous premalignant lesions in the Korean population.MethodsWe reviewed 1,292 cases (3,651 lesions) of patients with cutaneous premalignant lesions, including actinic keratosis (AK) and Bowen''s disease (BD), from the Department of Dermatology at Dong-A University Hospital (January 1995 to December 2013).ResultsThe average cutaneous premalignant lesion annual incidence was 1.82%, and the incidence continuously increased from 0.70% to 4.25% over the study period. The most common cutaneous premalignant lesion was AK (75.85%), followed by BD (24.15%). The mean age of onset was 68.76 years (men, 70.89 years; women, 65.56 years), and the male:female ratio of patients was 1:1.52. Major skin cancers, including squamous cell carcinoma (SCC, 8.90%), basal cell carcinoma (BCC, 6.42%), and malignant melanoma (MM, 0.70%), were detected in 15.79% of patients with cutaneous premalignant lesions. Three patients (0.23%) were previously diagnosed with both SCC and BCC. In addition, 59.13% of patients had a single lesion, while 40.87% had multiple lesions. Patient age, history of previous skin cancers, and occupation-related exposure to ultraviolet radiation were more common in patients with multiple lesions.ConclusionCutaneous premalignant lesion incidence has gradually increased in the Korean population.     

Pigmented Bowen's disease

Pigmented Bowen''s disease is rare, though more prevalent in men. It presents as a well-delineated plaque in areas unexposed to sun. There are reports of association with seborrheic keratosis, solar lentigo or exuberant pigmentation of genital and intertriginous regions. A specific dermoscopy finding is the presence of brown or gray dots in regular arrangement and coiled or dotted vessels. Thus, we aim to raise awareness of the diagnosis of pigmented Bowen''s disease in pigmented lesions.     

A Case of Vitiligo after Kawasaki's Disease

Vitiligo is a common skin disease, but its pathogenesis has not been fully determined, though an autoimmune etiology is considered likely. Kawasaki disease (KD) is an acute multisystem vasculitis of childhood associated with coronary arteriopathy, and is diagnosed based on clinical criteria. Furthermore, vitiligo has been associated with several other diseases, but no report has been issued about the relationship between vitiligo and Kawasaki''s disease. The author''s report the case of an 8-year-old male child that presented with depigmented lesions, which developed from the desquamative skin lesions of Kawasaki''s disease.     

5-氨基酮戊酸光动力疗法治疗鲍温病10例疗效观察

目的观察5-氨基酮戊酸光动力疗法治疗鲍温病的临床疗效。方法将20例鲍温病患者分为两组,各10例。治疗组予5-氨基酮戊酸外涂于皮损处,3h后予红光照射20min,能量密度100～120J/cm2,1次/周,共4周。对照组外涂5-氟尿嘧啶软膏皮损处,2次/d,共4周。结果治疗组完全缓解率为90.00%,对照组为30.00%,两组间完全缓解率比较,差异有统计学意义(P<0.05)。且治疗组均未见严重不良反应,对照组有溃疡及瘢痕等不良反应。结论 5-氨基酮戊酸光动力疗法治疗鲍温病临床疗效较好,且无严重不良反应,值得临床推广应用。     

Eccrine Syringofibroadenoma Associated with Bowen's Disease: A Case Report and Review of the Literature

Eccrine syringofibroadenoma (ESFA) is a rare, benign adnexal neoplasm which usually manifests as a solitary nodule on the extremities of elderly patients. Few case reports have described an association between ESFA and carcinomas including squamous cell carcinoma, porocarcinoma, and basal cell carcinoma. A 66-year-old male presented with a pruritic, erythematous brownish solitary plaque with crusted and verrucous surface on the extensor side of the right thigh. The lesion developed 6 to 7 years ago, and had been growing slowly. Biopsy revealed anastomosing epithelial strands which were composed of 2 areas: the upper area consisting of dysplastic cells with prominent nucleoli and abundant mitoses, and the lower area consisting of oval and round cells, and occasionally small luminal ducts. Dysplastic cells comprised almost the entire epidermis but did not invade into the dermis. Benign syringofibroadenomatous lesion surrounded the dysplastic cells in the lowermost portion of the epidermis. Although it is still unclear whether ESFA undergoes malignant transformation or it is a reactive change to carcinoma, complete excision should be performed to prevent malignant transformation with unknown risk.     

Apocrine Carcinoma of the Groin Possibly Associated with Extramammary Paget's Disease

Apocrine carcinoma is a rare malignancy with invasive potential. It presents as painless, slow-growing, firm or cystic, red nodules with focal ulcerations. The tumor is capable of hematogenous dissemination to the liver, lungs, and bone as well as lymphatic spread. In addition, apocrine carcinomas cause intra-epidemial pagetoid spread. We report a case of an apocrine carcinoma related with extensive extramammary Paget''s disease (EMPD). The relationship between apocrine carcinoma and EMPD remains to be understood. Co-existing cases with apocrine carcinoma and EMPD are discussed to better understand the relationship between these two malignant apocrine tumors.     

Orofacial Granulomatosis Associated with Crohn's Disease

Orofacial granulomatosis (OFG) is a term used to describe swelling of the orofacial area, mainly in the lips, secondary to an underlying granulomatous inflammatory process. OFG has been reported in association with systemic conditions such as sarcoidosis and Crohn''s disease (CD). OFG may precede gastrointestinal disease, such as CD, by several years and may be the only obvious focus of the disease. Herein, we report a patient with OFG and non-symptomatic ulcerations of the ileocecal valve. The patient received intralesional triamcinolone injections every 2 weeks. After 6 weeks, all oral lesions showed marked improvement. The favourable treatment response of this patient suggests that intralesional triamcinolone can be used as a treatment option for patients with CD that have oral lesions. In addition, patients presenting with OFG should be carefully evaluated for gastrointestinal signs and symptoms.     

An Unusual Clinical Presentation of Kimura's Disease Occurring on the Buttock of a Five-year-old Boy

Kimura''s disease is a rare inflammatory disorder of unknown etiology primarily seen in young Asian males. It is characterized by painless subcutaneous masses, blood and tissue eosinophilia, and markedly elevated serum immunoglobulin E (IgE) levels. Clinically, the subcutaneous nodules occur predominantly in the head and neck. However, we report the case of a five-year-old boy presenting with an asymptomatic solitary brown pigmented nodule on the left buttock diagnosed with Kimura''s disease. Here we describe the diagnosis and treatment of this unusual case.     

Efficacy of Imiquimod 3.75% for the treatment of extensive Bowen's disease of the face in an elderly patient

Bowen's disease is a cutaneous squamous cell carcinoma (SCC) in situ with a potential risk of progression to invasive SCC. Despite the high number of approved treatments, elderly patients with extensive lesions of critical sites may represent a therapeutical challenge, especially in cases of treatment failure or recalcitrant disease. Here, we report the successfully use of topical Imiquimod 3.75% to treat an extensive Bowen's disease of the cheek in an elderly.     

5-氨基酮戊酸光动力疗法治疗日光性角化病

目的探讨5-氨基酮戊酸光动力疗法(ALA-PDT)治疗日光性角化病的疗效。方法对16例日光性角化病患者进行ALA-PDT治疗,观察其疗效。结果 16例日光性角化病患者中14例治愈,2例复发。结论运用ALAPDT治疗日光性角化病疗效确切,无明显痛苦,患者乐于接受,复发率低,特别适合皮损位于面部等特殊部位或年龄较大不能耐受手术的患者,适合临床推广使用。     

Bowen's Disease: Statistical Study of a 10 Year Period

According to histological records, a total of 74 patients were diagnosed with Bowen's disease (B.d.) between 1 January 1984 and 31 December 1993 at the Department of Dermatology of Kitasato University. There was slight female predominance (36 ♂, 38 ♀), and 73% of the patients were older than 60 years; the mean age was 66.8 years. Fifteen patients had multiple (two-five) lesions. In 13 patients, other benign skin lesions were also found. Arsenic exposure as etiologic factor could have been present in 2 cases. Only 3 patients had other associated malignant tumors, which does not confirm the paraneoplastic nature of B.d. One-fifth of the lesions were on sun-exposed areas (head, neck and hands). Although we excluded invasive carcinomas from our statistical study, we mention the 8 invasive carcinomas developing from B.d. in that period. Histopathological classification of B.d. is uncommon. Classifying our cases by Darier's histopathological classification, 63.3% of them belonged to the lenticular type. The malignant potential of different histopathological types of B.d. needs further investigation.     

5-氨基酮戊酸光动力疗法治疗尖锐湿疣的进展

尖锐湿疣是由人乳头瘤病毒(HPV)感染所引起的一种常见性传播疾病。传统的微波、激光、冷冻等创伤性治疗后给患者带来痛苦且容易复发。5-氨基酮戊酸光动力疗法(ALA-PDT)治疗尖锐湿疣,尤其是特殊部位(如尿道、宫颈)的尖锐湿疣,具有疗效好、安全性高、复发率低等优势。ALA-PDT在治疗尖锐湿疣,并预防其复发方面有着良好的应用前景。本文就ALA-PDT在尖锐湿疣治疗中的基础研究及临床应用的进展进行综述。