Published on 19/03/2015 by admin
Filed under Dermatology
Last modified 19/03/2015
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Thomas D. Regan and Naomi Lawrence
Evidence Levels: A Double-blind study B Clinical trial ≥ 20 subjects C Clinical trial < 20 subjects D Series ≥ 5 subjects E Anecdotal case reports
Bowen’s disease and erythroplasia of Queyrat (EQ) are defined as intraepidermal squamous cell carcinoma, the latter occurring on the penis. The clinical appearance is that of a sharply demarcated, erythematous plaque that is persistent and slowly enlarging. Risk factors for the development of Bowen’s disease and EQ vary according to the site of disease, but generally include sun exposure, HPV (human papilloma virus) infection, arsenic exposure, radiation exposure, and HIV or other forms of immunosuppression.
The goals of treatment in both Bowen’s disease and EQ are cure and prevention of progression to invasive squamous cell carcinoma, while maintaining function and cosmesis. Invasive transformation of EQ is more common (10%) and metastasizes earlier than Bowen’s disease (3%). Multiple treatment options are available and no one treatment is ideal for all situations. Definitive treatment is surgical excision if the lesion is small and well defined. Mohs micrographic surgery (MMS) is recommended in the treatment of larger, ill-defined lesions, especially when preservation of normal tissue is crucial, as with EQ. Surgical ablation may be achieved with electrodesiccation and curettage, cryotherapy, or laser. Non-surgical options include imiquimod cream (a topical immunomodulator), topical 5-fluorouracil (5-FU), photodynamic therapy (PDT), and radiation therapy.
Standard of care requires that a follow-up period of no less than 5 years be observed to claim clinical cure of Bowen’s disease and EQ. Therefore, the extremely brief duration of follow-up for many studies is inadequate.
Skin biopsy
Dermoscopy
Immunoperoxidase studies for human papillomavirus
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The small sample size limits the application of this newly described diagnostic tool.
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The study found an odds ratio of 59 (95% confidence interval 5.4–645) for non-melanoma skin cancer in patients who were DNA positive for the high-risk mucosal HPV types 16, 31, 35, and 51.
Leibovitch I, Huilgol SC, Selva D, Richards S, Paver R. J Am Acad Dermatol 2005; 52: 997–1002.
Treatment of Skin Disease Comprehensive Therapeutic Strategies 4e
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Standard excision
Mohs micrographic surgery
