Warty and clear-cell Bowen's disease successfully treated with photodynamic treatment

ArticleinPhotodermatology Photoimmunology and Photomedicine 26(1):48-50 · February 2010with2 Reads
DOI: 10.1111/j.1600-0781.2009.00482.x · Source: PubMed
Abstract
Clear cell Bowen's disease (BD) is a rare histopathological subtype of BD, characterized by epidermal atypical keratinocytes with clear-cell changes exceeding 80% of the tumor population. Warty and clear cell Bowen's disease (WCCBD) is a recently described variant of clear cell BD, with verrucous and hyperkeratotic surface changes in addition to pathological features consisting of an extremely acanthotic epidermis, hyperkeratosis and clear-cell changes. Herein we present a 72-year-old man with a 1-year history of tumoral lesion located on the left cheek with a diagnosis of WCCBD, in whom we achieved excellent result with photodynamic treatment. To the best of our knowledge, this is the second reported case of this entity.
  • [Show abstract] [Hide abstract] ABSTRACT: A 54-year-old man presented with multiple lesions (seven) on the lower extremities and abdomen. These lesions had been present for at least 12 years with gradual growth and some had spontaneously disappeared; all were asymptomatic. Some of them had been treated with topical steroids and antimycotic creams with poor results. Past personal history was uneventful, but family history revealed the death of a son from metastatic visceral carcinoma. On dermatologic examination, six erythematous plaques of similar appearance were observed on the legs, abdomen and buttocks. All averaged 3 × 4 cm, with well-defined but irregular borders that did not seem to be infiltrated. On the skin surface, thick scales and crusts were present. Areas of spontaneous involution with residual hypopigmentation were present. On the dorsum of the left foot the biggest lesion was observed, measuring 4 × 8 cm. Unlike other lesions this was verrucous in appearance, with peripheral inflammation (Fig. 1). No ulceration or regional lymphadenopathies were present. General physical examination was unremarkable. Figure 1. The warty lesion located at the ankle Download figure to PowerPoint Histopathology revealed an intraepidermal carcinoma with an intact basal membrane, consistent with Bowen's disease. The presence of multiple clear cells was noted. The biopsy of the verrucous lesion showed an extreme thickening of the epithelium with the papilli reduced to very thin strands. The architectural features seemed to be fully disorganized. Numerous cells appeared highly atypical, with large, hyperchromatic nuclei. Multinucleated atypical cells were often present. Dyskeratotic cells with homogenous, strongly eosinophilic cytoplasm were numerous. The most distinctive feature was, however, the presence of multiple clear cells in the whole thickness of the epidermis. At some points there was effacement of the epidermal/dermal junction because of an intense chronic inflammatory reaction. Nevertheless, no atypicial cells were observed in the dermis (Fig. 2). Figure 2. Warty and clear cell Bowen's disease (Hematoxylin and Eosin, ×10) Download figure to PowerPoint All lesions were treated with cryosurgery except for the verrucous lesion, which was excised, and a full thickness skin graft was performed, whose donor site was the abdomen. The borders and bottom of the excised skin were free of tumor. The malignancy work-up was negative.
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  • [Show abstract] [Hide abstract] ABSTRACT: Topical photodynamic therapy (PDT) is a well-established treatment modality which has mainly shown to be effective for dermatooncologic conditions like actinic keratoses (AK), Bowen's disease, in situ squamous cell carcinoma and superficial basal cell carcinoma (BCC). However, a therapeutical benefit of PDT is also evident for inflammatory dermatoses like localized scleroderma, acne vulgaris and granuloma annulare. Recent work has been focused on the development and evaluation of topical photosensitizers like the heme precursor 5-aminolevulinic acid (5-ALA) or its methyl ester (methyl aminolevulinate) inducing photosensitizing porphyrins. These drugs do not induce strong generalized cutaneous photosensitization like the systemically applied porphyrins or their derivatives. For dermatological purposes, incoherent lamps or light-emitting diode arrays can be used for light activation. Depending on the applied light dose and the concentration of the photosensitizer either cytotoxic effects resulting in tumor destruction or immunomodulatory effects improving the inflammatory conditions occur. Treating superficial oncologic lesions (tumor thickness <2-3 mm) cure rates achieved by PDT are equal to the cure rates of the respective standard therapeutic procedure. The benefits of PDT are the low level of invasiveness and the excellent cosmetic results after treatment.
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