Multiple Bowen's Disease in a Patient Treated with Ruxolitinib: A Case Report and Extended Review of the Literature

Area of Science:

• Dermatology
• Oncology
• Pharmacology

Background:

• Ruxolitinib, a Janus kinase (JAK) 1/2 inhibitor, is approved for myelofibrosis and polycythemia vera.
• It is associated with an increased risk of non-melanoma skin cancer, including squamous cell carcinoma (SCC) and basal cell carcinoma.
• Bowen's disease (BD), an in situ form of SCC, is rarely reported in patients on Ruxolitinib.

Purpose of the Study:

• To report the first documented case of eruptive, multiple BD associated with long-term Ruxolitinib therapy.
• To highlight a potentially underrecognized cutaneous adverse effect of JAK inhibition.

Main Methods:

• Case report of a 53-year-old woman with polycythemia vera on Ruxolitinib for over 9 years.
• Monitoring of new skin lesions developing after Ruxolitinib dose escalation.
• Histopathological confirmation of BD and long-term follow-up.

Main Results:

• The patient developed multiple erythematous, hyperkeratotic plaques confirmed as BD.
• New BD lesions appeared approximately annually and were managed with cryotherapy or excision.
• No invasive SCC was observed during nearly a decade of follow-up.

Conclusions:

• This case represents the first fully documented instance of eruptive, multiple BD linked to long-term Ruxolitinib use.
• The chronic pattern observed suggests a potential underrecognized cutaneous adverse effect of JAK inhibition.
• Increased clinical awareness and further research into this association are warranted.