Clinico-pathological profile of Bowen’s disease in skin of colour: Experience from a teaching hospital in north India

Abstract

Background: Bowen’s disease (BD) is a squamous cell carcinoma in situ, commonly encountered in elderly population with an incidence reported as 15 cases per 100 000 people per year. It is considerably more common in Caucasian skin compared to skin of colour where it has not been studied extensively; the prevalence of BD in skin of colour is now known. Methods: A retrospective study was conducted in the Department of Dermatology, Venereology & Leprology. Hospital records of patients who were seen in the clinic between September 2017 and September 2022 [N= 228,194] were screened, records of patient who underwent biopsy were retrieved [N’= 1431]; eight patients (n=8) with clinical diagnosis of BD, confirmed on histopathology were included in the study Results: The mean age of patients included was 60.37±6.9 years with equal male and female [M:F=1]. The only risk factor identified was prolonged sun exposure seen in half the patients. The mean duration of the lesions at time of presentation was 3.27± 3.21 years. The most common site was trunk (62.5%) followed by lower limb (25%) and head & neck (12.5%). All, except one, had lesion over photo-protected sites. All patients presented with a well-defined plaque; morphological features included pigmentation (75%), scaling (75%), crusting (62.5%), erythema (25%) and ulceration (12.5%). The mean size of the lesion (plaque) at presentation was 5.50 ±3.02 × 5.71 ± 2.81 cm2 Biopsy was characteristic in all cases; features seen were atypia (100%), loss of polarity(100%), acanthosis (87.5%), hyperkeratosis(87.5%), parakeratosis(87.5%), hyperchromatic nucleus(87.5%), pleomorphism(87.5%), dyskeratotic cells (87.5%), mitotic figures(87.5%), “ Windblown appearance” (62.5%), pigment incontinence (62.5%) and dermal invasion (12.5%). The histological variants seen in our study were classical (62.5%), papillated (25%) and irregular (12.5%). Conclusion: We present here our experience of BD seen at our tertiary centre; there are limited case series from India describing BD. More prospective and population-based studies are needed in the future to determine the burden of the disease among Indians Background: Bowen’s disease (BD) is a squamous cell carcinoma in situ, commonly encountered in elderly population with an incidence reported as 15 cases per 100 000 people per year. It is considerably more common in Caucasian skin compared to skin of colour where it has not been studied extensively; the prevalence of BD in skin of colour is now known. Methods: A retrospective study was conducted in the Department of Dermatology, Venereology & Leprology. Hospital records of patients who were seen in the clinic between September 2017 and September 2022 [N= 228,194] were screened, records of patient who underwent biopsy were retrieved [N’= 1431]; eight patients (n=8) with clinical diagnosis of BD, confirmed on histopathology were included in the study Results: The mean age of patients included was 60.37±6.9 years with equal male and female [M:F=1]. The only risk factor identified was prolonged sun exposure seen in half the patients. The mean duration of the lesions at time of presentation was 3.27± 3.21 years. The most common site was trunk (62.5%) followed by lower limb (25%) and head & neck (12.5%). All, except one, had lesion over photo-protected sites. All patients presented with a well-defined plaque; morphological features included pigmentation (75%), scaling (75%), crusting (62.5%), erythema (25%) and ulceration (12.5%). The mean size of the lesion (plaque) at presentation was 5.50 ±3.02 × 5.71 ± 2.81 cm2 Biopsy was characteristic in all cases; features seen were atypia (100%), loss of polarity(100%), acanthosis (87.5%), hyperkeratosis(87.5%), parakeratosis(87.5%), hyperchromatic nucleus(87.5%), pleomorphism(87.5%), dyskeratotic cells (87.5%), mitotic figures(87.5%), “ Windblown appearance” (62.5%), pigment incontinence (62.5%) and dermal invasion (12.5%). The histological variants seen in our study were classical (62.5%), papillated (25%) and irregular (12.5%). Conclusion: We present here our experience of BD seen at our tertiary centre; there are limited case series from India describing BD. More prospective and population-based studies are needed in the future to determine the burden of the disease among Indians