Clinical Features And Treatment Of 64 Cases Of Bowen’s Disease

BackgroundBowen’s disease is a squamous cell carcinoma occurring in epidermis,also called squamous cell carcinoma in situ.Early lesions of Bowen’s disease lack specificity and are easily misdiagnosed as other diseases and delayed treatment.Although Bowen’s disease can be confined to the epidermis for a long time,it is still possible to break through the basement membrane and progress into invasive squamous cell carcinoma,which deteriorates patient’s quality of life and health.So early diagnosis and timely treatment are important.ObjectiveTo summarize the clinical,skin imaging and histopathological features of Bowen’s disease and raise awareness of Bowen’s disease.To analyze factors affecting clinicalmisdiagnosis of Bowen’s disease and reduce misdiagnosis rate.To analyze and compare the factors influencing the choice of therapeutic methods,and provide some reference for clinical work.MethodsThe clinical data of 64 patients diagnosed with Bowen’s disease by histopathological examination in dermatology Department of Qilu Hospital of Shandong University from January 1 2019 to December 31 2021 were collected.The gender,age,skin lesion characteristics,skin imaging findings,histopathology,treatment and prognosis of the patients were retrospectively analyzed.Results1.General information:Among the 64 patients,29 were male and 35 were female and the ratio was 1:1.21,the onset age was 25-94 years old,the median onset age was 61.50 years old,and the average onset age was(60.69±16.18)years old.The ratio of skin lesions in exposed and non-exposed sites was 1:1.21(29:35),There were 11 males and 18 females at the exposed site,18 males and 17 females at the non-exposed site.and the difference between male and female was statistically significant(P<0.05).The course of disease ranged from 3 months to 40 years,the mean course was(63.36±91.46)months,the median course was 24 months.2.Skin imaging:Among the 26 lesions examined by dermatoscopy,the background was brown to red,and 76.92%(20/26)of the lesions showed glomerular vessels or dots or globular vessels,and 80.77%of the lesions showed scabby surface.There were 3 cases of pigmented Bowen’s disease with brown spots and spherical structures under dermatoscopy.In the 6 lesions examined by Reflectance Confocal Microscopy,cuticle cells were disordered and the epidermis was atypical honeycomb,and there were target cells with high refraction in the center and low refraction in the periphery.3.Coincidence rate of clinical and pathological diagnosis:The coincidence rate of clinical and pathological diagnosis was 56.25%(36/64).Among the patients with consistent clinical and pathological diagnosis,10 cases were located at the exposed site and 26 cases were located at the non-exposed site;among the 28 patients with clinical misdiagnosis,19 cases were located at the exposed site and 9 cases were located at the non-exposed site,the difference was statistically significant(P<0.05).The lesions of patients with AK were all located at the exposure site,and the difference was statistically significant(P<0.001).4.Treatment:Among the 64 patients,49 patients received surgical treatment,14 patients received PDT,and 1 patient received cryotherapy.The difference between surgical treatment and PDT was not statistically significance(P>0.05).Among the 49 patients underwent surgical treatment,21 patients had skin lesions at the exposed site and 28 at the non-exposed site;among the 14 patients underwent PDT,12 patients had skin lesions at the exposed site and 2 at the non-exposed site,the difference was statistically significant(P<0.05).Conclusions1.Bowen’s disease mainly occurs in people aged 50 and above,with more females than males,and more lesions occur in non-exposed parts.2.The coincidence rate of clinical and pathological diagnosis of Bowen’s disease was 56.25%,and the misdiagnosis rate was as high as 43.75%.The location of the disease affects the clinical diagnosis.3.Under dermatoscopy,bowen’s disease has a red background,and the main vascular morphology is glomerulus or dot or globular vessels,with yellow or white scales.4.The choice of treatment for Bowen’s disease was correlated with the site of lesions,but not with gender,age,lesions size and course of disease.5.Both surgical resection and photodynamic therapy have good therapeutic effect on Bowen’s disease.When the aesthetic requirements are not high,surgical resection can be selected.