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Ding S, Hu L, Rao Y, Ren R, Tong X, Guo A, Huang J, Tang Z. Application of in vivo reflectance confocal microscopy in the diagnosis of Bowen's disease. Microsc Res Tech 2024. [PMID: 39031022 DOI: 10.1002/jemt.24645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 05/20/2024] [Accepted: 06/24/2024] [Indexed: 07/22/2024]
Abstract
Bowen's disease (BD) is a relatively rare early-stage squamous cell carcinoma in situ, most commonly affecting the middle-aged and elderly, and occurring on the skin or mucous membranes of various parts of the body. Its onset is concealed, the course of the disease is chronic, and some patients have malignant tumors outside the skin; therefore, it is necessary to diagnose and evaluate the disease at an early stage. This study aimed to investigate the application of reflectance confocal microscopy (RCM) in the diagnosis of BD. We performed RCM imaging on the lesion site and underwent skin biopsy for histological diagnosis of 92 patients initially diagnosed with BD in clinic. A retrospective analysis of the RCM result as well as the histological examination revealed that after analyzing RCM images, out of 92 biopsy lesions, 61 were diagnosed with BD, of which 54 were consistent with RCM diagnosis. Among the 59 cases diagnosed with BD by RCM, 54 cases were consistent with the histological diagnosis. Afterwards, we analyzed the RCM characteristics in patients with BD verified by biopsy, and compared the RCM images of two different lesions, classic Bowen's disease and pigmented Bowen's disease, and further summarized the key points of BD under RCM. Finally, we focused on the differential characteristics between BD and other skin diseases in RCM. RCM is of great value in the diagnosis of BD. RESEARCH HIGHLIGHTS: A retrospective study of RCM and histological diagnosis in patients with clinical diagnosis of BD. Analyze the RCM characteristics of skin lesions verified by biopsy. RCM is of great value in the diagnosis and differentiation of BD.
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Affiliation(s)
- Shu Ding
- Department of Dermatology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Lingxue Hu
- Department of Dermatology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yu Rao
- Department of Dermatology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ruijian Ren
- Department of Dermatology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xiaoliang Tong
- Department of Dermatology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Aiyuan Guo
- Department of Dermatology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jian Huang
- Department of Dermatology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zhen Tang
- Department of Dermatology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
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Zhang D, Fan H, Liu X, Wang S, Lang X, Ma W, Pang Y. Multiple Bowen's disease due to long-term narrow-band ultraviolet B phototherapy: A case report and literature review. J Cosmet Dermatol 2024; 23:1583-1587. [PMID: 38279518 DOI: 10.1111/jocd.16189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/18/2023] [Accepted: 01/05/2024] [Indexed: 01/28/2024]
Abstract
OBJECTIVE By presenting a case study on multiple instances of Bowen's disease and the consistent use of narrow-band ultraviolet B (NB-UVB) phototherapy over a three-year period, our aim is to enhance the comprehension of domestic clinicians regarding the disease. Additionally, we seek to review existing literature, encouraging dermatologists to consider clinical secondary primary lesion diagnoses. METHOD Our approach involves analyzing a diagnosed case of multiple Bowen's disease, examining clinical manifestations, histopathology, imaging results, and treatment methods related to NB-UVB phototherapy. We aim to facilitate discussion and understanding through a comprehensive literature analysis. RESULTS An elderly male with a 30-year history of psoriasis vulgaris initiated continuous NB-UVB therapy three years ago. A year later, he developed red patches and plaques with distinct borders and scaly surfaces on his face, trunk, lower extremities, and scrotum. Histopathological examination confirmed Bowen's disease. Treatment involved liquid nitrogen cryotherapy, with no recurrence observed during the one-year follow-up. CONCLUSION This case highlights that Bowen's disease, typically solitary, can manifest as multiple instances, especially in individuals with a history of psoriasis vulgaris. While NB-UVB stands as the primary treatment for psoriasis vulgaris, caution is warranted due to the potential risk of skin tumor induction with prolonged high-dose usage. Clinicians should be vigilant in monitoring and assessing the long-term implications of such therapies.
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Affiliation(s)
- Dong Zhang
- Department of Dermatology, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Huiping Fan
- Department of Dermatology, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Xuankai Liu
- Department of Dermatology, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Shuai Wang
- Department of Dermatology, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Xiaoqiao Lang
- Department of Dermatology, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Weiyuan Ma
- Department of Dermatology, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Yunyan Pang
- Department of Dermatology, Affiliated Hospital of Weifang Medical University, Weifang, China
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Cinotti E, Barbarossa L, Cortonesi G, Lamberti A, La Marca F, Tognetti L, Rubegni P, Perrot JL. Non-Invasive Imaging for the Diagnosis of Genital Warts and Their Imitators. J Clin Med 2024; 13:1345. [PMID: 38592196 PMCID: PMC10932056 DOI: 10.3390/jcm13051345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/07/2024] [Accepted: 02/22/2024] [Indexed: 04/10/2024] Open
Abstract
Genital warts are the most frequent sexually transmitted disease. Their clinical diagnosis is not always easy, and invasive skin biopsies for histological examination should be performed in these cases. The aim of the study was to investigate the use of non-invasive imaging techniques for the diagnosis of genital warts and their imitators. We retrospectively evaluated dermoscopy, reflectance confocal microscopy (RCM), and line-filed confocal microscopy (LC-OCT) images of nine patients with 19 warts of the mucous membranes and five patients with lesions that clinically mimic genital warts, including 12 molluscum contagiosum, 1 Fordyce's spot and one case of multiple acquired lymphangiomas. Most genital warts (15; 79%) showed dilated vessels surrounded by a whitish halo at dermoscopy. RCM and the new device LC-OCT could identify near histologic features such as the presence of hyperkeratosis, acanthosis, papillomatosis and enlarged vessels in all genital warts. However, the identification of koilocytes, which are the hallmark for the diagnosis of warts, was still difficult using both techniques. Non-invasive imaging techniques could also offer clues for the correct diagnosis of the imitators. This study confirmed the usefulness of dermoscopy in recognizing a precise pattern in warts and showed the potential use of RCM and LC-OCT to add additional findings to the clinical and dermoscopic examination.
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Affiliation(s)
- Elisa Cinotti
- Dermatology Section, Department of Medical, Surgical, and Neurological Sciences, Santa Maria Alle Scotte Hospital, 53100 Siena, Italy; (E.C.); (G.C.); (A.L.); (F.L.M.); (L.T.); (P.R.)
| | - Lorenzo Barbarossa
- Dermatology Section, Department of Medical, Surgical, and Neurological Sciences, Santa Maria Alle Scotte Hospital, 53100 Siena, Italy; (E.C.); (G.C.); (A.L.); (F.L.M.); (L.T.); (P.R.)
| | - Giulio Cortonesi
- Dermatology Section, Department of Medical, Surgical, and Neurological Sciences, Santa Maria Alle Scotte Hospital, 53100 Siena, Italy; (E.C.); (G.C.); (A.L.); (F.L.M.); (L.T.); (P.R.)
| | - Arianna Lamberti
- Dermatology Section, Department of Medical, Surgical, and Neurological Sciences, Santa Maria Alle Scotte Hospital, 53100 Siena, Italy; (E.C.); (G.C.); (A.L.); (F.L.M.); (L.T.); (P.R.)
| | - Francesca La Marca
- Dermatology Section, Department of Medical, Surgical, and Neurological Sciences, Santa Maria Alle Scotte Hospital, 53100 Siena, Italy; (E.C.); (G.C.); (A.L.); (F.L.M.); (L.T.); (P.R.)
| | - Linda Tognetti
- Dermatology Section, Department of Medical, Surgical, and Neurological Sciences, Santa Maria Alle Scotte Hospital, 53100 Siena, Italy; (E.C.); (G.C.); (A.L.); (F.L.M.); (L.T.); (P.R.)
| | - Pietro Rubegni
- Dermatology Section, Department of Medical, Surgical, and Neurological Sciences, Santa Maria Alle Scotte Hospital, 53100 Siena, Italy; (E.C.); (G.C.); (A.L.); (F.L.M.); (L.T.); (P.R.)
| | - Jean Luc Perrot
- Department of Dermatology, University Hospital of Saint-Etienne, 42100 Saint-Etienne, France;
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Cozma EC, Celarel AM, Stoenica IV, Lupu M, Banciu LM, Voiculescu VM. Correlations between Histopathological and Confocal Reflectance Microscopy Aspects in a Patient with Bowenoid Papulosis. Diagnostics (Basel) 2023; 13:diagnostics13091531. [PMID: 37174923 PMCID: PMC10177300 DOI: 10.3390/diagnostics13091531] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/05/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
Bowenoid papulosis is a cutaneous disease that is part of the spectrum of genital in situ carcinomas, caused primarily by infection with oncogenic strains of the HPV virus. The potential to transform into squamous cell carcinoma requires the diagnosis and treatment of the lesions. We present the case of a 34-year-old non-smoker without medical history who presented to our clinic for the appearance of multiple, asymptomatic, well-defined, flat, pigmented violaceous papules at the root of the penis in evolution for a year. Reflectance confocal microscopy (RCM) suggested the diagnosis of bowenoid papulosis, which was confirmed by histopathological examination. The treatment with Imiquimod 5% (3 times/week) and Isoprinosine (4 g/day) was initiated, followed by monitoring of the lesions by repeated RCM examination. The evolution of the patient at 6 weeks of therapy was favourable, with clinical remission of lesions and improvement in RCM aspects of the evaluated skin. In conclusion, RCM represents a useful noninvasive examination method that allows not only the diagnosis but also the follow-up of the treatment response in order to decide the appropriate length of therapy.
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Affiliation(s)
- Elena Codruta Cozma
- Department of Pathophysiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Department of Dermatology and Allergology, Elias University Emergency Hospital, 011461 Bucharest, Romania
| | - Ana Maria Celarel
- Department of Dermatology and Allergology, Elias University Emergency Hospital, 011461 Bucharest, Romania
| | - Ioana-Valentina Stoenica
- Department of Dermatology and Allergology, Elias University Emergency Hospital, 011461 Bucharest, Romania
| | - Mihai Lupu
- Department of Dermatology, MEDAS Medical Center, 030447 Bucharest, Romania
| | - Laura Madalina Banciu
- Department of Dermatology and Allergology, Elias University Emergency Hospital, 011461 Bucharest, Romania
| | - Vlad Mihai Voiculescu
- Department of Dermatology and Allergology, Elias University Emergency Hospital, 011461 Bucharest, Romania
- Department of Dermatology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
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Farabi B, Rao BK, Jain M. Identifying Pitfalls for Diagnosing Pigmented Bowen Disease on Reflectance Confocal Microscopy: Misleading Dendritic Cells. Dermatol Pract Concept 2023; 13:dpc.1301a30. [PMID: 36892388 PMCID: PMC9946061 DOI: 10.5826/dpc.1301a30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 02/04/2023] Open
Affiliation(s)
- Banu Farabi
- Department of Dermatology, New York Medical College, Valhalla, New York, NY, USA
- Department of Dermatology, NYC Health + Hospitals/Metropolitan, New York, NY, USA
- Department of Dermatology, NYC Health + Hospitals/Coney Island, Brooklyn, NY, USA
| | - Babar K. Rao
- Department of Dermatology, Weil Cornell Medical School, NY, USA
| | - Manu Jain
- Department of Dermatology, Weil Cornell Medical School, NY, USA
- Dermatology Department, Memorial Sloan Kettering Cancer Center, NY, USA
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Palaniappan V, Karthikeyan K. Bowen's disease. Indian Dermatol Online J 2022; 13:177-189. [PMID: 35287414 PMCID: PMC8917478 DOI: 10.4103/idoj.idoj_257_21] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 12/03/2021] [Accepted: 12/04/2021] [Indexed: 11/04/2022] Open
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Janowska A, Oranges T, Iannone M, Romanelli M, Dini V. Seborrheic keratosis-like melanoma: a diagnostic challenge. Melanoma Res 2021; 31:407-412. [PMID: 34132226 DOI: 10.1097/cmr.0000000000000756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This article summarizes the main epidemiologic and diagnostic features of seborrheic keratosis-like (SK-like) melanoma. We performed a review of the current literature. The real and current incidence and prevalence of SK-like melanoma are unknown. Many lesions are misdiagnosed and not excised with histopathologic confirmation, or excised without an appropriate surgical approach due to a benign clinical and dermoscopic appearance. SK-like melanoma presents both melanoma and SK features. SK-like melanoma and SK are often clinically indistinguishable even for experienced dermatologists. Clinically, it develops as a black-dark brown or light slightly elevated, papule, nodule or plaque with rapid growth and a regular or irregular shape. SK-like melanoma presents melanocytic and nonmelanocytic dermoscopic features. Irregular dark-brown dots/globules, a blue-grayish veil, streaks, irregular pigmentation or network and brown lines point to a melanoma diagnosis. Among the nonmelanocytic features, milia-like cysts and comedo-like openings have been highlighted. The association of polarized and nonpolarized dermoscopic techniques is more accurate for studying the dermoscopic features of SK-like melanoma. If the dermoscopic features are unclear, further investigations with reflectance confocal microscopy (RCM) or biopsy with histologic examination are essential. SK-like melanoma is a dermatologic challenge. Careful clinical and dermoscopic evaluation favor a correct diagnosis. In unclear cases, it is important to perform a biopsy with histologic examination to confirm the correct diagnosis.
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Affiliation(s)
| | - Teresa Oranges
- Department of Dermatology, University of Pisa, Pisa
- Department of Pediatrics, Dermatology Unit, Meyer Children's University Hospital, Florence, Italy
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