Clinical and histopathological characteristics, diagnosis and treatment, and comorbidities of Bowen’s disease: a retrospective study

Abstract

BackgroundBowen’s disease (BD) is a slow-growing precancerous skin condition, often concurrent with other diseases, with a high misdiagnosis rate. Previous studies show that patients with BD in different populations have differentiated characteristics.Materials and methodsA retrospective study was conducted in a tertiary hospital in Shenzhen, China. Data about demographic information, diagnosis and treatment, clinical and pathological characteristics, and comorbidities of 50 patients with BD were collected and analyzed.ResultsClinical data of onset age and disease course of 43 patients with BD were available, the average onset age of male and female patients are 55.1 (standard deviation (SD) = 15.29) and 58.2 (SD = 15.59) years old, respectively; the average disease course of male and female patients are 25.3 (SD = 28.63) and 33.9 (SD = 49.65) months, respectively. The onset age (p = 0.52) and disease course (p = 0.49) between male and female patients are not significantly different. Interestingly, there is a negative correlation between onset age and disease course (r = −0.245, p = 0.11). The correct rate of clinical diagnosis is relatively low (54.00%); Some patients with BD are misdiagnosed as Bowenoid papulosis (10.00%), actinic keratosis (8.00%), basal cell carcinoma (8.00%), seborrheic keratosis (6.00%), and pigmented naevus (4.00%). Trunk and limbs are the most common distribution sites of BD lesions, and 94.00% patients with BD are treated with surgical resection; 66.00% patients with BD had comorbidities, including skin diseases (48.48%), cardiovascular diseases (39.39%), gastrointestinal diseases (30.30%), respiratory diseases (27.27%), and tumors (18.18%). The most commonly observed histopathological characteristics of BD are squamous-cell hyperplasia (86.00%), disordered maturation with atypical keratinocytes (74.00%), atypical mitoses (60.00%), hyperkeratosis with hypokeratosis (48.00%), dermal inflammatory cell infiltration (36.00%), and koilocytosis (22.00%).ConclusionBD often occurs in middle-aged and elderly people and is easily misdiagnosed. The onset age and disease course of patients with BD are not significantly different between males and females, whereas there is a negative correlation between the onset age and disease course. BD is more likely to occur in trunk and limbs in the Chinese population, and most patients with BD are concurrent with comorbidities.

Surgical perspective on perianal Bowen's disease: A rare case report

“…While it has the potential to affect any part of the human body, Bowen's Disease (BD) typically manifests in sun-exposed areas [ 1 , 8 ]. Nevertheless, non-exposed regions may also be involved, as exemplified by its presentation in the anogenital region, as observed in our case [ 2 , 3 ]. It is more frequently observed in females within the age range of 20 to 45 years [ 9 ].…”

“…BD commonly manifests as a slowly growing, well-demarcated, erythematous, scaly patch or plaque [ 1 ]. Perianal Bowen's Disease is more frequently observed in women, and individuals with this condition may experience mild symptoms like itching or a burning sensation, as evident in our patient [ 1 , 3 ]. Within the anogenital region, the average size at the time of biopsy is approximately 1.3 cm 2 [ 1 ].…”

“…However, a skin biopsy is frequently required to achieve an accurate diagnosis of BD [ 1 ]. The epidermis exhibits hyperkeratosis and parakeratosis, along with pronounced acanthosis characterized by the elongation and thickening of rete ridges [ 1 , 3 ]. Keratinocytes display atypia that extends throughout the entire epidermis without breaching the dermo-epidermal junction.…”

“…Primary causal factors for BD involve exposure to ultraviolet light, immunosuppression, and infections with Human Papilloma Virus (HPV) [ 1 ]. BD frequently occurs in photo-exposed areas of skin, yet it can also affect other areas [ 2 , 3 ]. Histopathology stands as the gold standard diagnostic method for confirming the diagnosis [ 1 , 4 ].…”

“…Histopathology stands as the gold standard diagnostic method for confirming the diagnosis [ 1 , 4 ]. The therapeutic options currently accessible encompass topical chemotherapy, surgical approaches, light-based treatments, and destructive therapies [ 3 , 5 ]. Treatment considerations rely on various factors such as the site, size, immune status, patient's age, aesthetic outcomes, and other relevant factors [ 1 ].…”