Digital Bowen disease: a case report and systematic review

Digital Bowen disease (BD) is a rare type of squamous cell carcinoma in situ that affects the digits or nails. The aim of this review is to provide a comprehensive approach for the diagnosis and management of digital BD, which includes the use of reflectance confocal microscopy (RCM) as a diagnostic tool for non-glabrous skin. A literature search was conducted using the PubMed/Medline database from inception up to December 2023. A total of 160 articles were identified, and of these, 74 articles met the inclusion criteria. Both men and women are affected by the disease, with a higher proportion in males. Immunostaining for p16 is a useful surrogate marker of human papilloma virus infection, which is often present in digital BD. RCM criteria for BD has proven to be useful in diagnosing challenging cases, affecting the dorsal skin of the fingers. The available treatment alternatives for BD are imiquimod, 5-fluorouracil, photodynamic therapy, Mohs micrographic surgery, cryotherapy, and laser therapy. Digital BD is a challenging diagnosis that should be considered in cases of refractory warts and non-healing wounds. RCM can provide useful information during the work-up in selected cases. Surgical treatment and complete removal of the tumour is the treatment of choice. It is also important to consider the association between digital BD and human papillomavirus in order to rule out concomitant genital involvement.