Multiple-digit periungual Bowen's disease: a novel treatment approach with radiotherapy

Abstract

Multiple periungual Bowen disease [BD; also known as squamous cell carcinoma (SCC) in situ] is rare. The pathogenesis of the disease is linked to human papilloma virus, and in some instances to chronic immunosuppression. The usual management of periungual BD is by local excision, Mohs micrographic surgery or distal phalanx amputation. Our patient was offered radiotherapy in the hope of maximizing residual function and minimizing morbidity from treatment. A good response was seen at 2 months post-radiotherapy, but this was followed by relapses at 4 and 6 months post-radiotherapy. Persistent anonychia resulted in improved access to the involved skin, making topical therapy possible. Radiotherapy can be a valuable management approach for periungual SCC/BD in locations where amputation could result in substantial disability.

Squamous cell carcinoma of the skin: epidemiology, classification, management, and novel trends

“…Several case series suggest that well-differentiated, slowgrowing tumors of <1.0 cm in diameter can be removed by electrodessication and curettage (ED&C). 69 By contrast, SCCs on the back of the hand, the abdominal wall, and the lower limb are better treated with excision. One group of authors reviewed two studies of the efficacy of ED&C compared with that of standard excision of lowrisk SCC.…”

BritishAssociation ofDermatologists' guidelines for the management of squamous cell carcinomain situ(Bowen's disease) 2014

“…Radiotherapy has been employed with good functional and cosmetic benefit for isolated or multiple lesions where progression to SCC has occurred. 143,144 Other recently described treatments are represented in case reports of the use of imiquimod, 145 PDT 79,80 and CO 2 laser ablation. 146 …”

Bowen’s disease of the nail apparatus: a series of 8 patients and a literature review

“…One male patient suffered from polydactylous BD of fingers and toes. This case had been published before [6].…”

“…A rare subtype is polydactylous BD [4][5][6][7]. Human papilloma viruses (HPV) have been detected by in situ hybridization in numerous BD of the nail apparatus-HPV 16, 31/33, 56, and 71 [8][9][10][11].…”