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Bowen's disease on finger: a diagnostic and therapeutic challenge
Saurabh Singh1, Binod K Khaitan, Mehar Chand Sharma
1Department of Dermatology and Venereology, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
Abstract:
Bowen's disease commonly presents as a solitary asymptomatic plaque involving head and neck region or lower limbs. We present a case of a sixty seven-year-old man with an itchy, oozy, crusted solitary plaque on the right ring finger of eighteen months duration with histopathology consistent with Bowen's disease. The lesion was initially treated with topical 5% imiquimod but due to relapse and inadequate response to a second course, complete surgical excision followed by full thickness skin grafting was done. Recurrence after about 6 months in the form of a small papule adjacent to the initial site was also treated with excision. This report highlights the potential of Bowen's disease to mimic more common dermatoses and a high index of suspicion, supported by histopathology, is required to diagnose and treat it without delay, which in turn may require a multimodality approach. We also reviewed the current literature on the same.
Insights
Bowen's disease, a type of skin cancer, can appear on fingers and mimic other conditions. Early diagnosis via biopsy and multimodal treatment are key for effective management.
Area of Science:
- Dermatology
- Oncology
Background:
- Bowen's disease (squamous cell carcinoma in situ) typically presents as asymptomatic plaques on sun-exposed areas.
- Unusual presentations can delay diagnosis and treatment.
Observation:
- A 67-year-old male presented with an 18-month history of an itchy, oozy, crusted plaque on his right ring finger.
- Histopathology confirmed Bowen's disease.
Findings:
- Initial treatment with topical 5% imiquimod resulted in relapse.
- Complete surgical excision with full-thickness skin grafting was performed.
- A recurrence near the initial site required further excision.
Implications:
- Bowen's disease can mimic common dermatoses, necessitating a high index of suspicion and prompt histopathological confirmation.
- Multimodality treatment approaches may be required for challenging cases.
- This case underscores the importance of vigilance in diagnosing and managing atypical presentations of Bowen's disease.
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