Bowen's Disease Lesions Research Articles

Association of skin malignancies with various and multiple carcinogenic and noncarcinogenic human papillomaviruses in renal transplant recipients.

Organ transplant recipients receiving immunosuppressive treatment are prone to skin carcinomas on sun-exposed areas, and the frequency of such carcinomas in the long term reaches 40%. These carcinomas primarily are squamous cell carcinomas (SCC), which often are preceded by viral warts and premalignant keratoses. Human papillomaviruses (HPV) with other cocarcinogenic factors have been reported to play a role in the development of carcinomas in these patients. Five hundred renal-graft recipients referred to our department were examined for the presence of warts, precancerous keratoses, Bowen disease, keratoacanthomas, and basal and squamous cell carcinomas. Adequate material for histologic and virologic examination was obtained from 24 patients. An in situ molecular hybridization technique was performed using biotinylated DNA probes for HPV types 1a, 2a, 5, 16, and 18 under stringent conditions. HPV DNA was detected in 44 of 86 specimens, including 14 of 17 warts, 4 of 17 premalignant keratoses, 1 of 4 Bowen disease lesions, 8 of 12 keratoacanthomas, 3 of 4 tumors in which distinction between keratoacanthomas and SCC was difficult, and 14 of 30 SCC. Twenty-six of 44 positive specimens contained several HPV types, whereas 30 specimens contained oncogenic types. Benign types 1 or 2 were detected alone in five SCC. HPV types 16 and 18 (usually detected in genital lesions) were found in 26 samples from sun-exposed areas. Our results show that oncogenic and benign HPV often are detected within premalignant keratoses and SCC in organ transplant recipients, which suggests that HPV may play a role in the development of cutaneous malignancies.

Human papillomavirus infection and filaggrin expression in paraffin-embedded biopsy specimens of extragenital Bowen's disease and genital bowenoid papulosis

Cutaneous Bowen's disease (BD) and genital bowenoid papulosis (BP) are considered as precancerous or cancerous lesions that are sometimes infected with human papillomavirus (HPV). We studied retrospectively paraffin-embedded sections of 11 samples of cutaneous BD and 6 samples of genital BP from the general population for HPV infection and filaggrin expression. Using in situ hybridization with biotinylated probes of HPV types 1, 2, 5, 6, 11, 16, and 18, under stringent and/or non-stringent conditions and a streptavidin-alkaline-phosphatase complex for hybrid detection, HPV DNA was detected in 6/17 cases (5 BD and 1 BP). Positive nuclei were located in intermediate or upper epithelial cell layers. HPV 16 was found in 2 cases of BD but associated either with HPV 2 or 18. Three additional lesions reacted only under non-stringent conditions; HPV could not be typed with the probes used. The positive case of BP reacted with the four probe types 1, 2, 16, 18 and was negative with HPV 6 or 11. Viral antigen was not detected by indirect immunofluorescence with a rabbit antiserum directed to group-specific viral capsid antigen. Differentiation disorders were observed in the intermediate and upper cell layers of these specimens, as shown by a reduced expression of filaggrin/profilaggrin, a marker of terminal differentiation, in extragenital BD (7/11 cases), and an increased expression in genital BP (4/5 cases) although viral DNA was not always detectable. This study shows that in situ hybridization is a valuable technique for HPV DNA detection and its typing in BD and BP lesions on deparaffinized sections. The positive nuclei were located in the cell layers that exhibited abnormal expression of differentiation. There is no relation between the HPV infecting type and the filaggrin expression.

Treatment of Squamous Cell Carcinoma of the Skin

From 1964 to 1968, 417 squamous cell carcinomas of the skin and lower lip were treated, 347 have been followed up a minimum of four years. Two hundred eighty-one were treated by electrodesiccation and curettage (ED&C) with only three recurrences. Eighteen, treated with x-ray, yielded cures in all. Of 48 of the lower lip, 16 were treated by wedge resection, 29 by ED &C, and three by x-ray. Five recurred, two after wedge resection and three after ED&C giving an initial cure rate of 89.6%. Five recurrent lesions were retreated by the same or a different modality and all were cured for a final cure rate of 100%. Fiftytwo lesions of Bowen disease were treated by ED&C with only one recurrence. In selected squamous cell carcinomas of the skin the technique of biopsy, ED&C is excellent.