Is it Bowen’s, or something more serious?
The differential diagnosis of this lesion includes superficial spreading melanoma, pigmented basal cell carcinoma, atypical melanocytic nevus, and seborrheic keratosis. These different skin conditions may be difficult to distinguish on clinical examination and ultimately may require a biopsy.
Although pigmented Bowen’s disease can occur in anyone, Caucasian patients (as noted earlier) tend to have the more typical nonpigmented, erythematous scaly plaques in sun-exposed sites (FIGURE 3). Darker pigmented individuals are more likely to present with pigmented cutaneous lesions, which may mimic malignant melanoma,13 as was the case with our patient.
FIGURE 3
Nonpigmented Bowen’s disease
Surgical excision is extremely effective
Bowen’s disease can be treated with cryotherapy; curettage and electrodesiccation; surgical excision, including Mohs micrographic surgery; laser surgery; photodynamic therapy; radiation therapy; topical 5-fluorouracil; and topical imiquimod. Invasive or higher risk lesions require surgical excision or Mohs surgery. Surgical excision of SCCs is extremely effective, with 5-year cure rates of 92%.14
A delay in treatment for our patient
Our patient was scheduled to undergo surgical excision with graft repair of the site. However, she was receiving chemotherapy for mucinous adenocarcinoma of the pancreas and declined excision due to concerns about possible infection.
She later underwent curettage and electrodesiccation, followed by topical imiquimod therapy for 10 weeks. She remains free of any Bowen’s disease recurrences 2 years after her diagnosis.
Correspondence
Claudia Hernandez, MD, Department of Dermatology, University of Illinois at Chicago, 808 S Wood St, MC 624, Chicago, IL 60612-7300.