A Case of Bowen's Disease Successfully Treated with Ingenol Mebutate Gel.

Abstract

Bowen’s disease represents a form of squamous cellcarcinoma in situ and usually appears as a sharply demarcated erythematous plaque. It can be treated by surgery, curettage and cautery, cryotherapy, 5-fluorouracil (5-FU), laser therapy, radiotherapy, photodynamic therapy, or local or systemic injections of interferon alfa or gamma. Ingenol mebutate is a novel agent extracted from the sap of the plant Euphorbia peplus, which is known to have therapeutic effects on cancerous lesions. A 82-year-old woman visited to our clinic with 1 year history of walnut sized annular erythemaotus plaque on her right ankle. Skin biopsy was done and we could observe irregularly thickened epidermis and throughout the epidermis, the cells lie in disarray resulting in a “windblown” appearance with atypical mitoses. We applied ingenol mebutate 0.05% gel 3 consecutive days once daily to a 9cm2 contiguous field containing the affected area. The local skin reactions (erythema, vesiculation and scales) occurred as we expected. However, symptoms were transient and resolved spontaneously within 2 weeks after discontinuation. The lesion had disappeared almost completely with a mild pigmentation after 1 month. And also, she had not experienced any other adverse effects or recurrence over 2 months of follow-up. Herein we describe a case of Bowen’s disease successfully treated with ingenol mebutate gel.