Malattia di Bowen
Clinical, dermoscopic and histopathological findings of Bowen’s disease
A, Erythematous scaly patch. B, Glomerular vessels and scales. C, Dense growth of atypical keratinocytes in all layers (H&E, 100× original magnification, scale bar: 250 μm). D, Clumping cells (closed arrow), dyskeratotic cells (open arrow), and mitotic figures (closed triangle) (H&E, 400× magnification, scale bar: 50 μm) .
Copyright © 2020 Takada, Tomoaki (https://doi.org/10.1002/ccr3.3400), Clinical Case Reports published by John Wiley & Sons Ltd. CC BY 4.0
Indice
Fonti, link esterni, immagini, libri e approfondimenti
Introduzione
Bowen’s disease (cross-polarized photography is applied to enhance the visualization of the vascular pattern)
Copyright © 2018 Gaitanis et al. https://doi.org/10.1155/2018/9423949, Case reports in dermatological medicine (CC BY)
La malattia di Bowen è un carcinoma squamocellulare in situ con un rischio del 5% circa di evoluzione in carcinoma di Bowen, invasivo. Può insorgere sulla cute, sulle mucose e sulle aree di passaggio tra cute e mucose.
Colpisce soprattutto maschi di razza bianca dopo i 60 anni.
La localizzazione al glande prende il nome di eritroplasia di Queyrat.
Fattori di rischio
Sono fattori di rischio per lo sviluppo della malattia di Bowen:
- Età avanzata
- Sesso maschile
- Fototipo chiaro
- Esposizione cronica ai raggi UV
- Cheratosi da catrame
- Cheratosi arsenicale
- Cheratosi da radiazioni ionizzanti
- Immunodepressione
- Infezione da HPV
Presentazione clinica
La malattia di Bowen esordisce come una macula di colore rosa-rosso, desquamante, asintomatica, persistente, a limiti netti, che lentamente si estende, rilevandosi lievemente e ricoprendosi di piccole squame o squamo-croste, al di sotto delle quali la superficie appare leggermente granulosa ed essudante.
La lesione può essere singola o multipla, anche confluente.
Sono possibili forme pigmentate, polipoidi o verrucose.
In fase tardiva, possono comparire ulcerazioni e sanguinamento (segni di invasività ).
Bowen’s disease
Klaus D. Peter, Wiehl, Germany, CC BY 3.0 DE, via Wikimedia Commons
Bowen’s disease
Copyright © 2021 Fania et al. “Cutaneous Squamous Cell Carcinoma: From Pathophysiology to Novel Therapeutic Approaches.” Biomedicines. Licensee MDPI, Basel, Switzerland. CC BY 4.0
Bowen’s disease
Copyright © 2020 Lee et al. “Daylight Photodynamic Therapy: An Update.†Molecules. Licensee MDPI, Basel, Switzerland. CC BY 4.0
Bowen’s disease
Copyright © 2020 Shi et al. “Application of 5-aminolevulinic acid-photodynamic therapy in common skin diseases.†Translational Biophotonics, published by WILEY-VCH Verlag GmbH & Co. KgaA, Weinheim. CC BY 4.0
Bowen’s disease
Photos: Archives of the Department of Dermatology, Oulu University Hospital. Copyright © 2022 Sinikumpu et al. “Skin cancers and their risk factors in older persons: a population-based study.” BMC geriatrics (CC BY 4.0)
Pigmented Bowen’s Disease
Copyright © 2012 Ramirez-Fort, Marigdalia K. “Human papillomavirus-induced periungual pigmented Bowen’s disease.†Dermatology practical & conceptual, CC BY
Multiple Pigmented Bowen’s Disease: multiple hyperpigmented plaques and erosions of irregular shapes and sizes with and without scaling on the trunk.
Copyright © 2012 Pratik Gahalaut et al. “Multiple Pigmented Bowen’s Disease: A Diagnostic and Therapeutic Dilemma.†Case Reports in Oncological Medicine, Hindawi Publishing Corporation, CC BY
Eritroplasia di Queyrat
L’eritroplasia di Queyrat è una variante di malattia di Bowen che si localizza al glande.
Insorge solitamente dopo i 35-40 anni,
Si presenta come una chiazza eritematosa di colore rosso brillante, con superficie vellutata, di forma rotondeggiante o policiclica, a bordi netti, asintomatica. La lesione ha decorso cronico e, se non trattata, evolve verso la forma invasiva nel 10-30% dei casi (il rischio di evoluzione e di metastasi è nettamente superiore rispetto alla forma cutanea).
Erythroplasia of Queyrat of the glans and foreskin of the penis, appearing as a shiny, erythematous, and slightly infiltrated plaque.
Copyright © 2019 Yokoyama et al. “Erythroplasia of Queyrat treated with imiquimod 5% cream: The necessity of regimen guidelines.” Clinical Case Reports published by John Wiley & Sons Ltd. CC BY 4.0
Erythroplasia of Queyrat: erythematous bright red macules on the glans and the dorsal side of the penis.
Copyright © 2022 Kassel et al. “Erythroplasia of Queyrat (EQ), what dermoscopy can tell us.” Our Dermatol Online. CC BY
Il quadro istologico è quello della malattia di Bowen (vedere oltre).
L’evoluzione in carcinoma invasivo è piuttosto rapida.
Le neoplasie di piccole dimensioni possono essere asportate chirurgicamente; mentre quelle più estese, per le quali la chirurgia sarebbe troppo demolitiva, possono essere sottoposte a crioterapia, ablazione laser o diatermocoagulazione.
Diagnosi
La diagnosi di certezza richiede la biopsia.
La diagnosi differenziale si pone principalmente con:
- Carcinoma squamocellulare invasivo
- Cheratosi attinica
- Papulosi bowenoide
- Carcinoma basocellulare
- Psoriasi
- Eczema nummulare
- Tinea corporis
- Melanoma (dd con la malattia di Bowen pigmentata)
- Malattia di Paget (dd con l’eritroplasia di Queyrat)
- Lichen planus erosivo (dd con l’eritroplasia di Queyrat)
Dermoscopia
La dermoscopia mostra vasi puntiformi o glomerulari e una superficie squamosa.
Nella variante pigmentata sono presenti piccoli globuli marroni e aree pigmentate prive di strutture.
Dermoscopic structures of Bowen’s Disease
Copyright © 2021 Fania, Luca, et al. Licensee MDPI, Basel, Switzerland. CC BY 4.0
Bowen’s disease: (a) Clinically erythematous and slightly scaly flat lesions. (b) Dermatoscopy displays dotted and glomerular vessels and yellow crusts.
Copyright © 2014 Lallas et al. “The dermatoscopic universe of basal cell carcinoma.” Dermatology practical & conceptual, CC BY
Bowen’s disease
(A): Clinical image of a 12 × 8 mm nonpigmented Bowen’s disease of the chest with dermoscopic features of dotted and glomerular vessels (↑) and scaly white-to-yellow surfaces (×).
(B): Clinical image of a 30 × 12 mm pigmented Bowen’s disease of the leg with dermoscopic features of brown to gray globules/dots (↑) and structureless pigmentation (×) and dotted and glomerular vessels (>).
Copyright © 2021 Fania et al. “Cutaneous Squamous Cell Carcinoma: From Pathophysiology to Novel Therapeutic Approaches.†Biomedicines. Licensee MDPI, Basel, Switzerland. CC BY 4.0
Pigmented Bowen’s disease, dermatoscopic view
Copyright © 2012 Ramirez-Fort, Marigdalia K. “Human papillomavirus-induced periungual pigmented Bowen’s disease.†Dermatology practical & conceptual, CC BY
Istopatologia
L’istopatologia mostra una neoplasia intraepidermica a tutto spessore con:
- Acantosi
- Cheratinociti atipici, spesso discheratosici, con rapporto nucleo-citoplasma aumentato e nuclei ipercromici
- Mitosi frequenti
- Aumento della melanina e numerosi melanofagi nel derma papillare
- Infiltrato infiammatorio nel derma papillare
- Membrana basale integra
Bowen disease: medium-power magnification showing skin with full thickness epidermal dysplasia which is characterized by loss of the nuclear polarity, nuclear pleomorphism, and mitoses at all levels. The undulating deep epidermal contour and presence of eccrine ducts that have been colonized by the tumor cells (arrow) can potentially mimic invasion. (H&E, ×200).
Copyright © 2013 Tan et al. “Simulators of squamous cell carcinoma of the skin: diagnostic challenges on small biopsies and clinicopathological correlation.” Journal of skin cancer (CC BY)
Bowen disease: shave biopsy specimen showing mainly papillomatous epidermal lesion with hyperkeratotic horn. Inset: closer view of the underlying lesional epidermis shows cells with nuclear pleomorphism, prominent nucleoli, and frequent and abnormal mitotic figures. (H&E, ×20; Inset: ×400).
Copyright © 2013 Tan et al. “Simulators of squamous cell carcinoma of the skin: diagnostic challenges on small biopsies and clinicopathological correlation.†Journal of skin cancer (CC BY)
Bowen disease
(a) There is prominent dyskeratosis and aberrant mitoses at all levels of the epidermis, along with marked parakeratosis (100x). (b) Note, however, that the basement membrane remains intact (400x).
Copyright © 2011 Yanofsky et al. “Histopathological variants of cutaneous squamous cell carcinoma: a review.†Journal of skin cancer, CC BY
Bowen disease (Hematoxylin and Eosin, 100×)
Copyright © 2021 Fania et al. “Cutaneous Squamous Cell Carcinoma: From Pathophysiology to Novel Therapeutic Approaches.†Biomedicines. Licensee MDPI, Basel, Switzerland. CC BY 4.0
Bowen disease (Hematoxylin and Eosin, 100×)
Copyright © 2021 Fania et al. “Cutaneous Squamous Cell Carcinoma: From Pathophysiology to Novel Therapeutic Approaches.†Biomedicines. Licensee MDPI, Basel, Switzerland. CC BY 4.0
Trattamento
Se la lesione non è molto estesa, l’escissione chirurgica è la terapia migliore. In alternativa è possibile effettuare diatermocoagulazione, crioterapia o laserterapia.
