Bowen disease clinically presents as a plaque in covered as well as uncovered skin areas (Figure 19).
Not uncommonly, Bowen disease shows a markedly undulating basal contour and can be associated with subjacent dermal fibroplasia, raising the possibility of whether early invasion has occurred.
Indeed, the new guidelines rate the quality of data supporting PDT as first-line therapy for actinic keratoses, Bowen disease, and superficial BCCs as level IA--the highest-possible grade of evidence, requiring at least one well-designed, randomized, controlled trial, he noted at a satellite symposium held in conjunction with the 11th World Congress on Cancers of the Skin, cosponsored by the Skin Cancer Foundation and Erasmus University.
He said that he personally finds PDT particularly useful for treatment of large, superficial BCCs and Bowen disease. Surgical excision results in a nonsignificantly lower recurrence rate, but this is outweighed by PDT's markedly better cosmetic outcomes.
AVARIOUS skin problems can cause this appearance but in your age group, and in view of the long history and steady growth of the patch, it is possible you have
Bowen Disease. This is treatable but requires specialist advice.
Manifestations of chronic arsenicosis may appear after latent period between six months and 50 years or more.3,4,10 Bowen disease and squamous cell carcinoma may develop under arsenical keratosis.1,2,5 Diagnosis of arsenic intoxication is often difficult because clinical presentation varies depending on route of exposure, chemical form, dose, and time elapsed since exposure.
Marshall pointed out in a retrospective study that mortality from lung and bladder cancers increased in some regions of Chile where drinking water contained high levels of arsenic.12 Lee et al.10 reported a case where Bowen disease and small cell lung cancer were diagnosed as a cause of treatment with herbal medicine, which contained high levels of arsenic.
The main differential diagnosis of pagetoid dyskeratosis includes extramammary Paget disease, pagetoid spread of carcinoma cells, pagetoid
Bowen disease, and pagetoid melanoma.