Digital Bowen disease: a case report and systematic review

Area of Science:

• Dermatology
• Oncology
• Dermoscopy

Background:

• Digital Bowen disease (BD) is a rare squamous cell carcinoma in situ affecting digits and nails.
• It presents diagnostic challenges, particularly on non-glabrous skin.
• Human papillomavirus (HPV) infection is frequently associated with digital BD.

Purpose of the Study:

• To provide a comprehensive review of digital BD diagnosis and management.
• To evaluate the utility of reflectance confocal microscopy (RCM) in diagnosing digital BD.
• To discuss current and emerging treatment modalities for digital BD.

Main Methods:

• A systematic literature search was performed on PubMed/Medline up to December 2023.
• 160 articles were identified, with 74 meeting inclusion criteria for the review.
• Analysis focused on diagnostic criteria, management strategies, and prognostic factors.

Main Results:

• Reflectance confocal microscopy (RCM) offers valuable diagnostic criteria for digital BD, especially in difficult cases on dorsal finger skin.
• Immunostaining for p16 can serve as a surrogate marker for HPV infection in digital BD.
• Treatment options include topical therapies (imiquimod, 5-fluorouracil), photodynamic therapy, cryotherapy, laser therapy, and Mohs micrographic surgery.

Conclusions:

• Digital BD is a challenging diagnosis, often mimicking refractory warts or non-healing wounds.
• RCM is a useful adjunct for diagnosis in selected cases.
• Complete surgical excision is the primary treatment of choice, with consideration for potential HPV-related genital involvement.