Acta Dermato-Venereologica 99-7CompleteContent | Page 26

701 SHORT COMMUNICATION Successful Treatment for Extensive Bowen’s Disease using Daylight-mediated Photodynamic Therapy Roba SAFAR 1 , Alya ALKHARS 1 , Matthias TALLEGAS 2 , Nina KORSAGA-SOME 1,3 and Laurent MACHET 1,4 Departments of 1 Dermatology and 2 Pathology, CHRU Tours, FR-37044 Tours Cedex 9, France, 3 Department of Dermatology, CHU Yalgado- Ouédraogo, Ouagadougou, Burkina Faso, and 4 Inserm U1253, University of Tours, Tours, France. E-mail: [email protected] Accepted Mar 13, 2019; E-published Mar 14, 2019 Bowen’s disease (BD), or squamous-cell carcinoma (SCC) in situ, frequently presents as a persistent red scaly patch that grows slowly over time and may appear as an ulcer or thickened scar. It most commonly occurs on areas or high exposure to sunlight, such as the face, neck, chest, arms and legs. The risk of invasive disease is 3–5% (1). BD as actinic keratosis occurs more often in older patients with comorbidities and is frequently located on body sites with poor wound healing (1). Surgical removal is usually recommended. In some widespread lesions, surgical removal and reconstruction may be challenging. Photodynamic therapy (PDT) may be an alternative to surgery (2). We report here a case of extensive BD treated successfully with daylight PDT. CASE REPORT An 88-year-old man presented to our dermatology department in March 2017 with an erosive lesion on the scalp, present for 6 months. He had a 10-year history of actinic keratosis treated with cryotherapy and topical 5-fluorouracil, as well as surgical removal of one basal cell carcinoma and one squamous cell car- cinoma. The erosive lesion had started as a small erythematous lesion that gradually increased in size and became ulcerated with no other symptoms. Different types of dressings were tried, with no improvement. Clinical examination revealed an erosive plaque 10 cm in diameter, which was irregular with a sharply demarcated border (Fig. 1a). Dermoscopy revealed telangiectasia and glomeruloid vessels. A punched biopsy revealed an ulcerated lesion with fibrin necrotic leucocytes coating inflammatory granuloma associated with intense actinic damage, epidermal disorganization with dys- plastic keratinocytes, individual dyskeratotic cells and increased mitotic activity with atypical mitotic figures (Fig. 1d, e). On the basis of clinical and histological examination, the lesion was diagnosed as BD. Because of the advanced age of the patient and the wide area and location of the lesion, alternatives to surgical removal were considered, and these corresponded with the patient’s preference. The patient refused conventional PDT because of the possible associated pain. Daylight PDT was performed in August 2017 at 14.00 h. First, sunscreen (SPF 50+) was applied on the patient’s Fig. 1. Pre- and post-treatment appearance of extensive Bowen’s disease on the scalp in an 88-year-old man. (a) Before daylight photodynamic therapy (PDT). (b) Complete healing at 3 months, and (c) 9 months after therapy. (d) Pre-treatment histology of the lesion, low-magnification periodic acid-Schiff staining, shows superficial ulceration and actinic damage (magnification ×50). (e) Higher-magnification (×400), haematoxylin phloxine saffron staining shows, in a small area of remaining epidermis, dyskeratotic cells with marked nuclear atypia and mitotic activity with no dermal extension, consistent with Bowen’s disease. This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica. doi: 10.2340/00015555-3174 Acta Derm Venereol 2019; 99: 701–702