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| {{CMG}}{{AE}}{{VD}}
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| {{SK}}Bowen's disease, Bowenoid papulosis, Erythroplasia of Queyrat
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| ==Overview==
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| ==Historical Perspective==
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| EQ (erythroplasia of Queyrat) was originally described by Tarnovsky in 1891’ and appreciated as a penile disease by Fournier and Darier in 1893.’ However, not until 1911 was erythroplasia generally accepted as a distinct entity; this resulted from the intensive studies by Queyrat3 whose name the condition bears as an eponym to this day. A further milestone in the history of EQ was its recognition as carcinoma in situ by Sulzberger and Satenstein in 1933.4
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| Bowen disease
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| It was first described by the American dermatologist John T. Bowen in 1912. The etiology of Bowen's disease of the penis (BDP)
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| ==Classification==
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| ==Pathophysiology==
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| bp
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| Cases of patients with BP associated with HIV, lymphopenia, and depressed cell-mediated immunity have been reported in the literature.<sup>4</sup>
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| Additionally, the widening of spinous epidermal layer is seen with proliferation of atypical basal cells, coilocytosis, enlarged polimorfic and hyperchromatic nuclei as well as abnormal mitosis and hyper or parakeratosis with a collection of melanin
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| HPV types 16, 18, 31, and 39 play an etiologic role in BP.<sup>4</sup> HPV types 16, 18, 31, and 33 are considered the most oncogenic. HP-16 is the most commonly detected serotype. HPV typing may be useful to identify patients at high risk.
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| Erythroplasia of Queyrat
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| Its cause is unknown but chronic irritation, smegma, poor hygiene, genital herpes simplex, HPV, heat, friction, maceration, inflammation, phimosis, smoking (tar metabolites in urine), trauma, and specific prepuce dermatoses, such as LS or LP, may be risk factors for developing EQ.
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| EQ has been shown to be associated with co-infection with the rare epidermodysplasia verruciformis associated HPV-8 and the genital high-risk HPV-
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| Bowen disease
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| risk factors for developing this disease include lack of circumcision, HPV infection, phimosis, balanitis, or any chronic inflammation of the penile skin.<sup>43</sup> BD is associated with oncogenic HPV types 16 and 33.<sup>4</sup> Histologic features of BD include full-thickness epidermal atypia with disordered architecture, abnormal mitoses, dyskeratosis, and involvement of associated pilosebaceous apparatus with an intact epidermal junction.<sup>42</sup>
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| ==Epidemiology and Demographics==
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| The ratio of BD is approximately equal between men and women. BD occurs in adulthood, with the highest incidence in patients older than age 60 years. BD may arise anywhere on the skin.
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| Bowenoid papulosis generally occurs in sexually active men aged 20 to 40 years, equally in both sexes.<sup>47</sup>
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| ==Screening==
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| ==Natural History, Complications, and Prognosis==
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| ===Natural history===
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| The natural course of BP is not well defined. The papules may increase, decrease, or the lesions may disappear with time; however, coexistence of BP with and transmission into invasive carcinoma have been reported.<sup>49</sup> The risk for progression from BP to SCC is reported as 2.6%. BP may be associated with a lesser risk for squamous carcinoma than EQ and BDP.<sup>3</sup> It is believed that BP represents a low-grade form of SCCIS, which rarely, if ever, progresses to invasive disease but may be a risk factor for cervical neoplasia in the partners of affected men.<sup>41</sup>
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| ===Complications===
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| Both EQ and BD are premalignant, but transformation of EQ into invasive SCC is more common than in BD, with an incidence ranging from 10% to 33%.
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| *BP may progress to true BD or SCC.
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| Malignant potential of BD increases when its existence is compounded by concomitant disease such as HPV infection, LS or LP, or in patients with poor genital hygiene and smokers. The potential for invasive SCC to develop from BD is approximately 3% to 5% for cutaneous and 10% for genital lesions
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| ===Prognosis===
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| ==Diagnosis==
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| ===History and symptoms===
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| Well-demarcated, velvet patches with an irregular borders and plaques of keratinization
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| ===well-demarcated, erythematous plaque with an irregular borde , velvety patches and plaques of the keratinized penis.===
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| *
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| ===Physical examination===
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| Bowen disease
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| BD may arise anywhere on the skin. It is usually persistent and progressive, presenting as a gradually enlarging, well-demarcated, erythematous plaque with an irregular border and surface crusting or scaling. BD also may occur on mucous membranes. BD of the penis is characterized by red, sometimes slightly pigmented, scaly, moist, velvety patches and plaques of the keratinized penis.<sup>3. and 44.</sup> BD may be asymptomatic or associated with pain and pruritus. Compared with BP, BD evolves relatively more often into an invasive carcinoma. A delay in diagnosis of BD often is encountered because the lesion is asymptomatic. A classic clinical history is presentation of a non–steroid-responsive dermatosis.<sup>4</sup>
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| BP
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| BP usually presents with multiple, small, well-demarcated, grey-brown, red, pink, or skin-colored papillomatous papules or small patches on the penile shaft, glans, or foreskin, vulva, and perianal area .The papules are nonpruritic, range in size from 2 to 10 mm, and usually lack scale.
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| EQ
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| Clinically, EQ appears as single or multiple red, shiny, slightly raised, sharply demarcated, velvety, non-healing plaques associated with scaling, crusting, and sometimes bleeding, affecting the mucosal surfaces of the penis.
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| Ulceration or distinct papillomatous papules within a plaque may indicate progression to invasive SCC.
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| ===Laboratory findings===
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| EQ
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| A definite diagnosis is made by a biopsy showing the typical histologic picture of intraepidermal carcinoma ''in situ''. Early invasion should be excluded by obtaining several biopsies
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| ==Treatment==
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| Bowen disease
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| The choice of treatment depends on an analysis of various factors such as lesion size, number, site, degree of functional impairment, modality availability, and cost. Follow-up at 6 to 12 months is recommended to evaluate for recurrence. Treatment options are local excision, Mohs micrographic surgery, cryotherapy, curettage with cautery⁄electrocautery, laser therapy with carbon dioxide, argon, and Nd:YAG lasers. Cryotherapy regimens consist of two freeze–thaw cycles of 20 seconds with a thaw period at intervals of a few weeks. Other noninvasive treatment options are photodynamic therapy, topical 5-FU.<sup>14</sup> 5-FU is used clinically as a 5% cream once or twice daily for a variable period, ranging from 1 week to 3 months. Topical treatment for BD in perianal region may minimize the risk for scarring, poor wound healing, and functional impairment. For perianal BD, excision with wide margin is recommended. Surgery and destructive treatment modalities have a significant risk for scarring, deformity, and impaired function. Recent case studies have reported the successful treatment of penial BD and anogenital BD with topical imiquimod, an immune response modifier, as a 5% cream. The ideal dosing regimen is still under investigation, but the most studied regimen is imiquimod 5% cream once daily for 16 weeks.<sup>43., 44. and 45.</sup>
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| BP
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| Treatment options for BP usually involve locally destructive or ablative therapies such as cryosurgery, electrodessication, laser vaporization (Nd:YAG, argon, and carbon dioxide lasers), and surgical excision. Scarring can be seen with these modalities. Conservative treatment for BP so far has been based on topical use of ointments and creams containing 5-FU, podophylin, retinoic acid, and cidofovir; only moderate effects have been reported.<sup>47. and 48.</sup> Recently, some authors reported successful clearance of BP using imiquimod cream 5%.<sup>4., 47. and 48.</sup>
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| EQ
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| Circumcision is recommended for all patients because it eliminates the mucosal surface of the prepuce and decreases the risk for local recurrence.<sup>52</sup> Treatments for EQ include surgical excision, Mohs micrographic surgery, cryotherapy, electrodesiccation and curettage, radiotherapy, laser ablation, PDT, oral isotretinoin, topical 5-FU and topical imiquimod. Mohs micrographic surgery may be useful because it precisely identifies tumor-free margins while allowing minimal tissue loss. Partial or total penectomy is usually an unnecessary mutilating procedure. If urethral involvement is noted, treatment may be more challenging, with higher recurrence rates.
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| ===General measures===
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| Good hygiene which include retracting the foreskin regularly and gentle cleansing of entire glans, preputial sac, and foreskin were found effective in treating the diseases.
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| ===Medidical Therapy===
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| ===Surgery===
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| ===Photodynamic therapy===
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| ===Miscellaneous therapies===
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| ==Prevention==
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| ===Primary Prevention===
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| ===Secondary prevention===
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| ==References==
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