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

Abstract

Bowen's disease of the nail apparatus is uncommon. Since often characteristic clinical features are missing, diagnosis and treatment are delayed. We have analyzed our patients' files from January 2001 to July 2015 for this disorder. We identified eight patients with Bowen's disease of the nail apparatus, six male and two female individuals. Fingers were more often affected than toes. The disease does not respect the anatomical borders of the nail apparatus. Therefore, we performed delayed Mohs surgery with skin grafts in seven patients and with second intention healing in one patient. Two relapses were noted but only one ate the same digit. Since relapses occurred after 2-3 years, a follow-up of such patients seems justified.

Mohs micrographic surgery for nail unit tumours: an update and a critical review of the literature

“…It is characterized by a full thickness epidermal dysplasia with pagetoid intraepidermal distribution of atypical keratinocytes . BD of the nail unit is usually located in the lateral nail folds and presents as a verrucous or hyperkeratotic band, associated with lateral onycholysis and often a marginal band of melanonychia . Differential diagnosis includes viral warts, onychomycosis and psoriasis.…”

“…BD frequency in the nail unit may be underreported, as most authors described these tumours among SCC series. Both the pigmented and non‐pigmented variants have been correlated to the presence of human papilloma virus (HPV) . Surgical removal using MMS (Figs and ) has shown high cure rates, ranging from 78% of the cases in a long follow‐up by Young et al, and in 6 of 8 cases reported more recently by Wollina .…”

“…Both the pigmented and non‐pigmented variants have been correlated to the presence of human papilloma virus (HPV) . Surgical removal using MMS (Figs and ) has shown high cure rates, ranging from 78% of the cases in a long follow‐up by Young et al, and in 6 of 8 cases reported more recently by Wollina . Other treatments such as imiquimod 5%, photodynamic therapy and CO 2 laser have been proposed, but no trials comparing the efficacy of these techniques with respect to the conservative treatment with MMS have been published to date …”

“…3 BD of the nail unit is usually located in the lateral nail folds and presents as a verrucous or hyperkeratotic band, associated with lateral onycholysis and often a marginal band of melanonychia. 1,3 Differential diagnosis includes viral warts, onychomycosis and psoriasis. BD frequency in the nail unit may be underreported, as most authors described these tumours among SCC series.…”

Bowen disease of the nailfold: dermoscopic diagnosis

“…Matrix or nail bed disease may result in nail plate changes, leading to misdiagnosis as onychomycosis or trauma‐induced nail dystrophy. Dermoscopy may further aid the diagnosis of Bowen disease by showing clustering dot‐like or glomerular vessels . However, when keratinization is extensive, not allowing the visualization of underlying features, differentiation of Bowen disease from verruca vulgaris is very difficult, requiring histopathological diagnostic procedures.…”