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| CASE REPORT |
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| Year : 2018 | Volume
: 9
| Issue : 2 | Page : 103-104 |
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Giant bowen's disease in a paddy field worker
Divya Nair, Betsy Ambooken, Neelakandan Asokan
Department of Dermatology, Government Medical College, Thrissur, Kerala, India
| Date of Web Publication | 27-Nov-2018 |
Correspondence Address:
Dr. Divya Nair
23/384, Kumkumam, Kanattukara, Thrissur, Kerala
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/mjmsr.mjmsr_30_18
Bowen's disease (BD) is a squamous cell carcinoma (SCC) in situ with the potential for significant lateral spread. Progression to invasive SCC is rare. A 64-year-old female paddy field worker presented with a giant-sized BD on the back of the trunk. Traditional clothing (short blouse with dhoti) which exposed the back of the trunk to long hours of sunlight might explain the location of the lesion. In spite of extensive lateral spread, there were no features to suggest deeper invasion.
Keywords: Giant Bowen's disease, paddy field worker, ultraviolet light
How to cite this article:
Nair D, Ambooken B, Asokan N. Giant bowen's disease in a paddy field worker. Muller J Med Sci Res 2018;9:103-4 |
| Introduction | |  |
Bowen's disease (BD) is a squamous cell carcinoma (SCC) in situ with the potential for significant lateral spread. It can be genital or extragenital in location. Genetic factors, trauma, exposure to ultraviolet light, arsenic and other chemical carcinogens, X-rays, and human papillomavirus infection are the major risk factors for the disease.[1] The risk of progression into an invasive carcinoma is 3%–5% in extragenital lesions and about 10% in genital lesions.[1] We report an unusual case of giant BD involving the back of the trunk in a paddy field worker.
| Case Report | | |
A 64-year-old female paddy field worker presented with asymptomatic gradually enlarging, scaly plaque of 3-year duration. There was no improvement on application of topical herbal medications. She used to work in the sun for long hours wearing short blouse and dhoti. Cutaneous examination revealed a single large triangular-shaped plaque of size 35 cm × 20 cm on the back of the trunk. The surface of the plaque showed coarse scaling in some areas and atrophy in other areas [Figure 1]. Differential diagnoses of BD, lupus vulgaris, and giant porokeratosis were considered. Histopathological examination showed hyperkeratosis, parakeratosis, acanthosis, and an intact basement membrane. Atypical keratinocytes with loss of polarity, vacuolization and abnormal mitoses, dyskeratotic cells, and multinucleated cells were seen on the entire breadth of the epidermis resulting in the characteristic “windblown appearance” of BD [Figure 2]a and [Figure 2]b. The patient was referred to oncology department for radiotherapy as surgical excision was impractical. | Figure 1: Large triangular-shaped plaque of size 35 cm × 20 cm on the back of the trunk with the surface of the plaque showing coarse scaling in some areas and atrophy in other areas
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 | Figure 2: (a) Epidermis showing characteristic windblown appearance (H and E, ×100). (b) Atypical keratinocytes with loss of polarity, vacuolization and abnormal mitoses, dyskeratotic cells, and multinucleated cells on the entire breadth of the epidermis (H and E, ×400)
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| Discussion | | |
BD was first described by the American dermatologist John. T. Bowen in 1912. Giant extragenital forms of Morbus Bowen are extremely rare. BD has a multifactorial etiology. The clinical manifestations of BD are varied.[2] In our case, the lesion was localized to a site and habitually exposed to sunlight owing to her mode of dressing and occupation. In spite of extensive lateral spread, there was no ulceration or induration to suggest vertical spread.
Other premalignant epithelial dermatoses related to sun exposure are actinic keratoses and disseminated superficial actinic porokeratosis. BD is more prone for invasive SCC than actinic keratoses.
Treatment options for BD include cryotherapy, curettage, cautery, photodynamic therapy, laser destruction, surgical excision, topical 5-fluorouracil, topical imiquimod, and radiotherapy.
Bakardzhiev et al. reported a case of extragenital giant BD on the right flank which was treated with imiquimod.[2] Shankar et al. described a giant pigmented BD on the lower abdomen where traditional garment caused constant friction.[3] Nagakeerthana et al. reported a giant BD over the right gluteal region which was treated with wide local excision.[1] Sotiriou et al. reported a giant BD located on the right frontotemporal area.[4]
On searching the literature, we did not find any case of giant extragenital BD of the back of the trunk in paddy field workers. The location of this lesion on a habitually sun-exposed area underlines the role of ultraviolet light in the pathogenesis of BD. It is advisable to use protective clothing in workers who are exposed to direct ultraviolet light for prolonged duration.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Nagakeerthana S, Rajesh G, Madhavi S, Karthikeyan K. Bowen's disease: Two case reports of a giant and dwarf lesions. J Cancer Res Ther 2017;13:371-3.  |
| 2. | Bakardzhiev I, Chokoeva AA, Tchernev G. Giant extragenital Bowen's disease. Wien Med Wochenschr 2015;165:504-7. |
| 3. | Shankar AA, Pinto M, Shenoy MM, Krishna S. Giant pigmented Bowen's disease: A rare variant at a rare site. Indian Dermatol Online J 2015;6:S63-4. [ PUBMED] [Full text] |
| 4. | Sotiriou E, Lallas A, Apalla Z, Ioannides D. Treatment of giant Bowen's disease with sequential use of photodynamic therapy and imiquimod cream. Photodermatol Photoimmunol Photomed 2011;27:164-6. |
[Figure 1], [Figure 2]
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