Multiple Bowen's Disease:A Case Report And Literature Review

Background: Bowen's disease is a kind of squamous cell carcinoma within the epidermis,also known as squamous cell carcinoma in situ.It occurred in skin and mucous membranes of elderly patients mostly.Most of the lesions were single,a few for multiple or even widespread.It is a chronic disease,the exact etiology and pathogenesis is not clear now,that most can not find the exact reason.There are a lot of causes that can lead to the disease,such as exposure to arsenic trioxide,human papillomavirus(HPV)infection,trauma,chronic light damage,genetic factors and so on.In China and abroad there are many literature reported that long-term exposure to arsenic can cause skin cancer,including the occurrence of Bowen's disease.The carcinogenicity of the arsenic is clear,which can enter human body by a variety of ways,causing long-term harm.In clinical,arsenic exposure is not uncommon.Although we have many ways to measure in vivo arsenic poisoning degree,for example,blood,urine,hair,nails and so on,there have been reports that after six months of cessation of exposure,these results tend to be almost normal.While the characteristic lesions such as hyperkeratosis,pigmentation and so on may disappear over time,resulting in arsenic exposure of the pathogenic factors are ignored.Asking clinical history,we should be more comprehensive,in-depth and detailed to determine the source of arsenic exposure as far as possible.Patients should be reminded to be avoid a arsenic exposure and some related factors.And reminding the patient avoid the kind of factor and some related factors.Nowadays there are many ways to help diagnosing the disease,but the gold standard of diagnosing is still the pathological examination.There are many methods to treat this disease,the clinicians should choose the suitable treatment method according to the patient's actual situation.The disease have the possibility of recurrent and complicated with other tumors,which need long-term follow-up.Case presentation: A 46-year-old female presented with scattered multiple papules and plaques with itching for more than 4 years.The patients has pesticides and fertilizers sale history for 2 years about 15 years ago.Physical examination: The heart and lung examination was no abnormalities,and superficial lymph nodes were not palpable.Dark red papules and plaques occurred on the right shoulder,both sides of the wrist,calf and feet,ranging from0.5cm×0.5cm to 3cm×2.5cm in size circular and irregular shaped.And the surface of them were dry,part of the surface of the skin rash thick crusts and scales attached,attrib border and clear.The skin lesions on the rightwrist the crusts fell off,slight erosion and exudation on basal part.The mucosal parts were not involved.The biopsy of the lesion on right foot back show that the epidermis irregular proliferous hypertrophy,disordered arrangement of cells,atypical hyperplasia,visible dyskeratosis cells and pathologic mitosis.Histopathologic diagnosis is Bowen's disease.The postoperative pathological of all the lesions show all conform with the pathological characteristics of the Bowen's diease.Finally diagnosis is multiple Bowen's disease.The patient is still in follow-up after surgical resection.Conclusion:1.Multiple Bowen's disease is rare.This patient had a clear history of exposure to arsenic compounds.The patient got this disease when she was on longer exposed to the arsenic compounds for more than 10 years.Because the time is too long,the level of arsenic poisoning could not be measured.Asking clinical history,we should be more comprehensive,in-depth and detailed to determine the source of arsenic exposure as far as possible.Patients should be reminded to be avoid a arsenic exposure and some related factors.And reminding the patients avoid the kind of factor and some related factors.2.There are many ways to treat the disease.The best treatment options should be chosen based on the actual situation of patients.