Authors: Cynthia Angela Karim, MD, Elisabeth Ryan, MD, Reynaldo L. Ugalde, MD, FPDS


Bowen’s disease (BD) is generally regarded as a premalignant dermatosis. If untreated, 3% to 5% of patients may develop invasive carcinoma, which is capable of metastasizing and may even cause death. Clinically, the lesions of BD present as a scaly, slightly elevated, erythematous plaque with surface fissures and foci of pigmentation. These lesions affect fair-skinned individuals more frequently and are equally distributed on the exposed and nonexposed parts of the body. Etiologies are ultraviolet radiation exposure, immunosuppression, exposure to ionizing radiation, and infection with human papillomavirus. Variety of the treatments are (a) surgical and destructive therapies (excision, Mohs micrographic surgery, curettage with or without electrosurgery, chemoablation with TCA, and cryosurgery), (b) topical therapies (5-FU and 5% imiquimod cream), and (c) nonsurgical ablative therapies (laser ablation, radiotherapy, and PDT). We present a 56 years old male, present with 3 years of chonic plaque with central ulcer and erosions and initially diagnosed as lichen simplex chronicus. Skin punch biopsy showed confluent parakeratosis of the stratum corneum, acanthosis of the epidermis with numerous large keratinocytes with vesicular nuclei, prominent nucleoli, and abundant cytoplasm, mitotic figures and also lymphocytes and plasma cells in the dermis. The patient underwent CO2 laser at our institution. Meticulous examination is important to diagnose BD. The choice of treatment for BD should take into account the patient’s general condition, the site and size of the lesion, and available treatments. Patient follow‐up is recommended because of the risk of late recurrence.





Bowen Disease, premalignant dermatosis, CO2 laser

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