Evaluation of Bowen disease by in vivo reflectance confocal microscopy

摘要

Madam, Bowen disease (BD) is a form of epidermal carcinoma in situ, characterized histologically by proliferation of atypical, pleomorphic keratinocytes involving the whole epidermis. Dyskeratotic, mitotic and multinucleated cells frequently occur. Clinically, BD should be differentiated from other non-melanoma skin cancers (NMSC) and from inflammatory dermatoses such as eczema or psoriasis. Although BD develops as an in situ carcinoma, it may progress into invasive squamous cell carcinoma (SCC) in 3-5% of cases, with a potential risk for metastasis of up to 10%. Dermatoscopy has been applied as an adjunct imaging technique for the diagnosis of pig-mented and nonpigmented BD, showing a peculiar dermato-scopic pattern characterized by glomerular vessels and a scaly surface in 100% and 90% of cases, respectively. However, the diagnosis of BD is usually based on histological examination of a skin biopsy. In vivo reflectance confocal microscopy (RCM) is a novel noninvasive diagnostic tool that has recently been applied for the evaluation of various skin diseases, including actinic keratosis, basal cell carcinoma and psoriasis. Here we report the RCM features of BD and correlate them to the corresponding histological features.