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Introduction: Bowen's disease is a squamous cell carcinoma in situ, the most common malignancy of the nail unit. Presenting more frequently in the fingernails, common risk factors include ionizing radiation, oral exposure to arsenic or pesticides, dyskeratosis congenita, and quite commonly diverse subtypes of HPV. We report the first case of multiple periungual pigmented Bowen's disease in a pediatric patient. Case Presentation: A healthy 13-year-old boy presented with a 9-month history of a pigmented erythematous patch on the proximal nail fold of his 3rd right finger without associated symptoms. A punch biopsy was taken, and the diagnosis of Bowen's disease was made. The patient received photodynamic therapy and three cycles of imiquimod without response, and two new lesions appeared on the first and second right fingers. Surgical removal was performed on all lesions. A polymerase chain reaction detected an HPV type 16. Discussion/Conclusion: Multiple periungual Bowen's disease is rare, with the most frequent risk factors being HPV infection and chronic immunosuppression. Less than 10% of the cases present as longitudinal melanonychia. To date, there are no previous reports of multiple pigmented periungual Bowen's disease. HPV-induced Bowen's disease is usually present in adults aged between 22 and 89 years as persistent verrucae. In this case, koilocytosis and the fact that all lesions appeared on the right hand are suggestive of HPV infection.
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RESUMEN La enfermedad de Bowen es un carcinoma espinocelular in situ que afecta tanto piel como mucosas y que puede progresar hacia un carcinoma espinocelular invasor. Clínicamente se caracteriza por: una placa eritematosa bien definida, de crecimiento lento, bordes irregulares, bien delimitados y escamas o costras suprayacentes. El cuadro clínico se confirma con los datos histopatológicos donde se advierte carcinoma in situ espinocelular. Se presentó un paciente de 35 años con lesión en la piel del hemitórax derecho de 3 años de evolución. Al examen dermatológico presentaba: lesión en placa eritematosa, única, bordes bien definidos, de tamaño 2x2 cm de diámetro, de forma anular, con escamas finas en su superficie, localizada en hemitórax derecho. La piel perilesional mostraba daño actínico crónico. Se realizó exéresis y biopsia de la lesión. Los resultados de la biopsia informaron que el aspecto histológico es consistente con carcinoma espinocelular in situ (enfermedad de Bowen).
ABSTRACT Bowen's disease is a squamous cell carcinoma in situ that affects both skin and mucosa and may progress to invasive squamous cell carcinoma. It is clinically characterized by a well-defined, slow-growing erythematous plaque with irregular, well-demarcated borders and overlying scales or crusts. The clinical presentation is confirmed by histopathological data showing squamous cell carcinoma in situ. We present a 35-year-old male patient with a skin lesion on the right hemithorax of 3 years of evolution. On dermatological examination he presented a single erythematous plaque lesion located on the right hemithorax, with well-defined borders, 2x2 cm in diameter, annular shape and fine scales on the surface. The perilesional skin showed chronic actinic damage. Exeresis and biopsy of the lesion were performed. The biopsy results reported that the histological appearance was consistent with squamous cell carcinoma in situ (Bowen's disease).
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Doença de BowenRESUMO
Abstract The penile localization of pigmented Bowen's disease has been rarely reported and has been mostly related to human papillomavirus infection. Early diagnosis and treatment are important to prevent progression to invasive squamous cell carcinoma. However, diagnosis can be challenging because it may be difficult to distinguish from melanoma, even using dermoscopy. Reflectance confocal microscopy may be useful in suggesting the bedside diagnosis before the histopathological confirmation. A case of penile pigmented Bowen's disease is described along with its dermoscopy and reflectance confocal microscopy findings and their correlation with histopathology.
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Humanos , Neoplasias Cutâneas/diagnóstico por imagem , Doença de Bowen/diagnóstico por imagem , Microscopia Confocal , Dermoscopia , Diagnóstico DiferencialRESUMO
The penile localization of pigmented Bowen's disease has been rarely reported and has been mostly related to human papillomavirus infection. Early diagnosis and treatment are important to prevent progression to invasive squamous cell carcinoma. However, diagnosis can be challenging because it may be difficult to distinguish from melanoma, even using dermoscopy. Reflectance confocal microscopy may be useful in suggesting the bedside diagnosis before the histopathological confirmation. A case of penile pigmented Bowen's disease is described along with its dermoscopy and reflectance confocal microscopy findings and their correlation with histopathology.
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Doença de Bowen , Neoplasias Cutâneas , Doença de Bowen/diagnóstico por imagem , Dermoscopia , Diagnóstico Diferencial , Humanos , Microscopia Confocal , Neoplasias Cutâneas/diagnóstico por imagemRESUMO
The aim of the present article is to report the case of a young patient with bowenoid papulosis who was a carrier of other sexually-transmitted infections (STIs), such as HIV and high-grade vulva lesion (usual-type vulvar intraepithelial neoplasia, VIN), and to demonstrate the strategy used to manage the case, as well as to discuss important issues regarding the standardization of intraepithelial lesions. (AU)
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Humanos , Feminino , Pessoa de Meia-Idade , Neoplasias do Ânus/cirurgia , Neoplasias Vulvares/cirurgia , Infecções por Papillomavirus/cirurgia , Neoplasias do Ânus/terapia , Neoplasias Vulvares/terapia , Doença de Bowen/diagnóstico , Infecções por Papillomavirus/terapiaRESUMO
Este artigo apresenta um ensaio teórico sobre as contribuições de Murray Bowen para a Terapia Familiar Sistêmica. Apesar de ser um dos pioneiros da psicologia sistêmica, suas obras nunca foram publicadas em português. Dada a importância da teoria de Bowen para o campo da terapia familiar, este trabalho visa discutir alguns aspectos teóricos e práticos que podem ajudar os profissionais no trabalho com famílias. A partir da descrição dos sistemas emocional, afetivo e intelectual, apresentam-se os oito conceitos de Bowen, com destaque para a diferenciação do self e sua importância na proposta terapêutica boweniana. São ressaltadas duas características distintas da Terapia Familiar Sistêmica de Bowen: a diferenciação do self do terapeuta e a terapia familiar com um só membro da família.
This article is a theoretical essay on Murray Bowen's contributions to systemic family therapy. Despite being one of the pioneers of systemic psychology, his works were never published in Portuguese. Given the importance of Bowen's theory for the field of family therapy, this work aims to explore some theoretical and practical aspects that can help professionals in working with families. From the description of the emotional, affective and intellectual systems, eight concepts of Bowen's theory are presented, highlighting the self differentiation and its importance in the Bowenian therapeutic proposal. Two distinct characteristics of Bowen's Systemic Family Therapy clinic are highlighted, the differentiation of the therapist's self and family therapy with a single family member.
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Bowenoid papulosis (BPap) is an uncommon skin disorder linked to human papillomavirus (HPV) infection and characterized clinically by the presence of scattered papules or small plaques, multiple and pigmented, that involve the stratified squamous epithelium. Bowen disease (BD) is recognized as the main differential diagnosis of BPap. An 80-year old white woman was referred for the evaluation of multiple, brown verrucous papules measuring 3 to 4 mm in diameter on the right maxillary gingiva. Histopathological analysis revealed disturbed epithelial maturation with papillary stratified squamous epithelium, koilocytic dysplasia, parakeratosis, acanthosis, basal double-layer, loss of cellular polarity, nuclear hyperchromatism and pleomorphism, scattered mitosoid bodies, and a high degree of cytologic atypia. An immunohistochemical investigation for p53 and Ki67 showed staining of the basal and suprabasal layer, while p16 was strongly expressed in the nuclei of epithelial cells and Bcl-2 was positive only in mitosoid bodies and the lymphocytic inflammatory infiltrate. In situ DNA hybridization was negative for HPV. Oral BPap is an uncommon lesion in which the diagnostic process includes clinical, histopathological, and molecular correlations due to the similarity to aggressive behavior lesions such as BD.
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Doença de Bowen/diagnóstico , Doenças da Gengiva/diagnóstico , Doenças da Gengiva/patologia , Neoplasias Cutâneas/diagnóstico , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , HumanosRESUMO
This article addresses the natural history of the human papilloma virus (HPV) infection to anal squamous intraepithelial lesions, and onto squamous cell carcinoma of the anus. This article provides overviews of the virology, pathophysiology, nomenclature, classification, historical terms, risk factors, clinical evaluation, differential diagnosis, and treatment of HPV infection and its sequelae.
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La enfermedad de Bowen es un carcinoma de células escamosas intraepidérmico con potencial invasor que se ve con mayor frecuencia en mayores de 60 años. Se presenta usualmente como una placa eritematosa de crecimiento lento en zonas fotoexpuestas. Presentamos el caso de una mujer de 65 años con carcinoma escamoso in situ variedad pagetoide localizado en la mama izquierda en el cual fue determinante la inmunohistoquímica para realizar el diagnóstico final.
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Abstract: Bowen's disease is a type of squamous cell carcinoma in situ of the skin. The pigmented form is rare and represents less than 2% of cases. We report a case of a 74-year-old black man with a blackened and asymptomatic leg injury for about 6 months. Clinically, and under dermatoscopy, the injury was suggestive of melanoma or melanoacanthoma, and a definitive diagnosis was made by histopathological examination.
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Humanos , Masculino , Idoso , Neoplasias Cutâneas/patologia , Doença de Bowen/patologia , Ceratose Seborreica/patologia , Pele/patologia , Dermoscopia , Diagnóstico Diferencial , Melanoma/patologiaRESUMO
La enfermedad de Bowen es un carcinoma in situ de células escamosas, que puede progresar a un carcinoma epidermoide invasor, por lo que se requiere un diagnóstico y tratamiento adecuados. Se presenta el caso de una mujer de 74 años, con enfermedad de Bowen en el tórax posterior, una localización poco frecuente, la que fuera tratada con crioterapia.
Bowen's disease is an squamous cells carcinoma in situ of that can progress to an invasive squamous cell carcinoma, so an adequate diagnosis and treatment are required. We present the case of a 74-year-old woman with Bowen's disease in the posterior thorax, a rare location, which was treated with cryotherapy.
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Abstract: Bowen's disease is an in situ squamous cell carcinoma of the skin with only 2% of pigmented cases reported. It is clinically characterized by papules and plaques of blackened surface that may be caused either by sun damage - usually in photoexposed areas in elderly individuals - or by human papillomavirus infection - usually in the anogenital region of young adults. Dermoscopic aspects of Bowen's disease are discussed for over a decade, but with no definitive criteria that would lead to a definitive diagnosis. We present a case of Bowen's disease affecting the finger of a 57-year-old Asian patient. The lesion clinically and dermoscopically simulated a melanoma. Histopathological findings suggested the diagnosis of pigmented Bowen's disease. Pigmented Bowen's disease should be considered a differential diagnosis of melanoma, since its clinical and dermoscopic criteria are unspecific. Histopathological examination remains the gold standard for the diagnosis of the disease.
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Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Cutâneas/patologia , Doença de Bowen/patologia , Infecções por Papillomavirus/patologia , Mãos/patologia , Melanoma/patologia , Diagnóstico DiferencialRESUMO
BACKGROUND: Fast and non-invasive analytical methods, as in fluorescence spectroscopy, have potential applications to detect modifications of biochemical and morphologic properties of malignant tissues. In this study, we propose to analyze the fluorescence spectra using k-Nearest Neighbours algorithm (k-NN) and ratio of the fluorescence intensity (FI) to differentiate skin disorders of distinctive etiologies and morphologies. MATERIALS AND METHODS: Laser-induced autofluorescence spectra upon excitation at 408nm were collected from basal cell carcinoma (BCC) subtypes (n=45/212 spectra), psoriasis (PS) (n=37/193 spectra) and Bowen's disease (BD) (n=04/19 spectra) lesions and respective normal skin at sun-exposed (EXP) and non-exposed (NEXP) sites of the same patient. RESULTS: The mean ratios of FI values at selected wavelengths of emission (FI600nm/FI500nm) were significantly lower in BCC and PS lesions compared to EXP [P=0.0001; P=0.0002, respectively]; but there were no significant differences between abnormal conditions. The analysis of fluorescence spectra using k-NN can discriminate normal or abnormal skin conditions (EXP, BCC, BD, PS) of distinctive etiology, neoplastic or inflammatory (BCC, BD and PS) and morphologies (nodular and superficial BCC, BD and PS) as high as 88% and 93% sensitivity and specificity means, respectively; also, similar erythematous-squamous features (superficial BCC, BD and PS) with 98% and 97% sensitivity and specificity means, respectively. The k-NN computational analysis appears to be a promising approach to distinguish skin disorders.
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Fármacos Fotossensibilizantes/uso terapêutico , Dermatopatias/diagnóstico , Dermatopatias/patologia , Espectrometria de Fluorescência/métodos , Doença de Bowen/diagnóstico , Doença de Bowen/patologia , Carcinoma Basocelular/diagnóstico , Carcinoma Basocelular/patologia , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/patologia , Humanos , Psoríase/diagnóstico , Sensibilidade e Especificidade , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologiaRESUMO
ABSTRACT Pigmented Bowen's disease is a rare subtype of Bowen's disease. Clinically it presents as a slow-growing, well-defined, hyperpigmented plaque, and should be included as a differential diagnosis of other pigmented lesions. The authors describe a challenging case of pigmented Bowen's disease with non-diagnostic dermscopy findings.
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Humanos , Feminino , Idoso , Transtornos da Pigmentação/patologia , Neoplasias Cutâneas/patologia , Doença de Bowen/patologia , Carcinoma de Células Escamosas/patologia , Nádegas , Diagnóstico DiferencialRESUMO
Abstract Porokeratosis is a disorder of epidermal keratinization characterized by the presence of annular hyperkeratotic plaques. Its etiopathogenesis is not yet fully understood, but a relationship with immunosuppression has been reported. Dermoscopic examination revealed a classic yellowish-white ring-like structure that resembled “volcanic crater contour” – the so-called cornoid lamella. We describe a case of porokeratosis in a female patient with chronic lymphedema, which was similar to Bowen’s disease due to the many glomerular vessels seen on clinical examination and dermoscopy.
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Humanos , Feminino , Idoso , Doença de Bowen/patologia , Doença de Bowen/diagnóstico por imagem , Poroceratose/patologia , Poroceratose/diagnóstico por imagem , Dermoscopia/métodos , Doença Crônica , Diagnóstico Diferencial , Eritema/patologia , Eritema/diagnóstico por imagem , Linfedema/patologia , Linfedema/diagnóstico por imagemRESUMO
Basal cell carcinoma is the most common form of skin cancer, especially in elderly people. Pigmented basal cell carcinoma is a rare subtype and has been described in the literature as a nodular and hyperpigmented lesion; rarely, it can appear as an extensive pigmented plate, which may be clinically indistinguishable from superficial spreading melanoma and Bowen disease. Dermatoscopy has a high sensitivity in the diagnosis of basal cell carcinoma. When Menzies criteria are used; however, the final diagnosis is made by histopathology. The objective of the present report is to analyze the case of a patient with pigmented basal cell carcinoma simulating a superficial spreading melanoma.
El carcinoma basocelular es el cáncer de piel más frecuente, especialmente en personas de edad avanzada. El carcinoma basocelular pigmentado es una variante poco común que se ha descrito en la literatura como una lesión nodular hiperpigmentada. En raras ocasiones puede presentarse en forma de una extensa placa pigmentada, la cual puede ser clínicamente indistinguible del melanoma maligno de extensión superficial y de la enfermedad de Bowen. La dermatoscopía tiene una alta sensibilidad en el diagnóstico del carcinoma basocelular, cuando se utilizan los criterios de Menzies, aunque el diagnóstico final es histopatológico. El objetivo del presente trabajo es reportar y analizar el caso de una paciente con un extenso carcinoma basocelular superficial pigmentado, que simula un melanoma maligno de extensión superficial.
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Carcinoma Basocelular/diagnóstico , Melanoma/diagnóstico , Neoplasias Cutâneas/diagnóstico , Doença de Bowen/diagnóstico , Doença de Bowen/patologia , Carcinoma Basocelular/patologia , Dermoscopia/métodos , Feminino , Humanos , Melanoma/patologia , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Neoplasias Cutâneas/patologiaAssuntos
Doença de Bowen/diagnóstico , Dermoscopia/métodos , Melanoma Amelanótico/diagnóstico , Neoplasias Cutâneas/diagnóstico , Biópsia por Agulha , Doença de Bowen/patologia , Diagnóstico Diferencial , Feminino , Humanos , Hipopigmentação/patologia , Imuno-Histoquímica , Melanoma Amelanótico/patologia , Microscopia Confocal/métodos , Pessoa de Meia-Idade , Neoplasias Cutâneas/patologiaRESUMO
Abstract: BACKGROUND: Most available studies on the efficacy of topical photodynamic therapy focus on short-to medium-term results. Long-term data are scarce. OBJECTIVE: To evaluate the long-term efficacy of photodynamic therapy with topical methylaminolevulinate to treat Bowen's disease and basal cell carcinoma in the clinical practice setting of a dermato-oncology department. METHODS: The study included patients diagnosed with Bowen's disease or basal cell carcinoma, and who received photodynamic therapy from 2004 to 2008. Treatment protocol and clinical follow-up were standardized. The primary endpoint was clinically observed recurrence in a previous photodynamic therapy-treated area. Descriptive and survival analyses were performed. RESULTS: A total of 31 Bowen's disease lesions and 44 superficial basal cell carcinoma were treated, with a median follow-up of 43.5 months. Recurrence was observed in 14 Bowen's disease lesions (53.8%) and in 11 superficial basal cell carcinoma (33.3%). Significantly higher estimates for recurrence rates were found in patients with Bowen's disease (p=0.0036) or those aged under 58 years (p=0.039). The risk of recurrence was higher in patients with Bowen's disease than in those with superficial basal cell carcinoma and younger patients. CONCLUSIONS: Recurrence should be considered when choosing to treat non-melanoma skin cancer with photodynamic therapy. Younger age and Bowen's disease were independent predictors for long-term recurrence, suggesting the need to establish an extended period of follow-up for this subset of patients.
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Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ácido Aminolevulínico/análogos & derivados , Doença de Bowen/tratamento farmacológico , Carcinoma Basocelular/tratamento farmacológico , Recidiva Local de Neoplasia , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/uso terapêutico , Neoplasias Cutâneas/tratamento farmacológico , Administração Cutânea , Fatores Etários , Ácido Aminolevulínico/uso terapêutico , Seguimentos , Estudos Retrospectivos , Medição de Risco , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do TratamentoRESUMO
Melon plants (Cucumis melo L.) are grown in the state of Rio Grande do Norte (RN), the largest producer of melons in Brazil, with plastic mulch and agrotextiles. Studies of crop evapotranspiration (ET) under these conditions are required to ensure adequate irrigation. This study aimed to determine the crop coefficients (Kc) of irrigated melon plants grown with mulch and agrotextiles in the region of Mossoró, RN, based on the Bowen Ratio Energy Balance (BREB) method. Two experiments were conducted at different times during the 2009/2010 season in a melon producing area (4°59'52" S, 37°23'09" W, and 54 m elevation) to define ET and Kc. Due to the plastic cover and reduced precipitation during the experiments, the Kc obtained by the BREB method was considered the basal Kc - KcbBREB. The results were compared with the Kcb from the FAO 56 Bulletin. There was close agreement between BREB and FAO ET measurements (12 % underestimation by the FAO method for the entire crop season), with sizeable differences only during the initial phenological stage. The mean KcbBREB values of the two field campaigns were 0.26, 0.96 and 0.63 for the initial, midseason and late stages, respectively. The high KcbBREB value in the initial growth phase may be related to the effect of the plastic mulch and agrotextiles on the energy balance at the surface. The relationship between KcbBREB and fc had high correlation, making possible an estimation of the melon Kcb based on the level of crop ground cover.