English

Abstract

A 50 year old female presented with complaints of asymptomatic, raised skin lesion over left leg for the past two years, which on local examination revealed a single, localized, well defined, rounded plaque of 4 cm. Clinically Bowen's disease was not suspected because of its rarity and also occurred in the unusual site. Biopsy was taken and sent for histo-pathological examination. In histo- pathological examination Bowen's disease was diagnosed. This case is highlighted to show the pathologist's help in making a proper diagnosis when atypical skin lesions are seen at unusual sites. INTRODUCTION: Most of the overt malignant conditions actually originate as microscopic lesions, which are designated as in-situ carcinomas. These in-situ carcinomas are typically noticed as intra- epithelial lesions, most often seen in squamous cell epithelial lined tissue eg. oral mucosa, genitals, cervix and skin. In skin, the intra-epithelial carcinoma-in situ lesions may be Bowen's disease, Bowenoid papulosis or Erythroplasia of Queyrat. In the same way gastrointestinal and urinary system also can show in-situ malignancies. Bowen's disease was first described by an American dermatologist John T Bowen in the year 1912. It is most commonly reported in sun exposed sites. It rarely occurs in patients with darkly pigmented skin. Bowen's disease is observed in skin and external genitals and is sometimes associated with arsenic poisoning and visceral carcinomas. Bowen's disease is a rare, persistent, progressive, intra-epithelial carcinoma, 8% of which will develop into an invasive squamous cell carcinoma. Treatment options are topical 5-fluorouracil, cryotherapy or surgical excision. Further a detailed clinical examination is needed along with supportive diagnostic aids to exclude the possibility of any internal malignancy. A wide excision is to be done to prevent invasive malignant tumor.