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CORRESPONDENCE
Year : 2011  |  Volume : 56  |  Issue : 3  |  Page : 353-354
Bowen's disease on palm: A rare presentation


Department of Dermatology, Venereology, & Leprology, Seth G.S. Medical College & KEM Hospitals, Parel Mumbai - 400 008, India

Date of Web Publication30-Jun-2011

Correspondence Address:
Manoj Harnalikar
Department of Dermatology, Venereology, & Leprology, Seth G.S. Medical College & KEM Hospitals, Parel Mumbai - 400 008
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.82497

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How to cite this article:
Harnalikar M, Dongre A, Khopkar U. Bowen's disease on palm: A rare presentation. Indian J Dermatol 2011;56:353-4

How to cite this URL:
Harnalikar M, Dongre A, Khopkar U. Bowen's disease on palm: A rare presentation. Indian J Dermatol [serial online] 2011 [cited 2019 Jun 25];56:353-4. Available from: http://www.e-ijd.org/text.asp?2011/56/3/353/82497


Sir,

Bowen's disease is a rare, persistent, progressive intraepidermal carcinoma, which may be potentially malignant, with up to 8% of the cases progressing to squamous cell carcinoma. Bowen's disease may occur at any cutaneous site, which includes the areas protected from as well as exposed to sunlight. The involvement of the dorsum of the hand is not rare, but that of the palmar aspect is highly unusual. [1] Very few cases have been published in literature about Bowen's disease occurring on the palm.

The patient was a 42-year-old woman, from Mahad district, Raigad, Maharashtra. She is a farm worker by occupation, and presented to us with reddish raised itchy lesion over the right palm since last 15 years. She mentioned a gradual increase in the size of the lesion over past few months. She had a history of excessive exposure to the sun and contact with fertilizers. Her systemic examination was unremarkable. On cutaneous examination, she had well-marginated, erythematous, mildly scaly crusted plaque on the right palm, the size of which was approximately 5×6cm [Figure 1]. No similar lesions were found elsewhere on the body. Skin biopsy performed from the lesion showed marked hyperkeratosis, an irregularly acanthotic epidermis with nuclear pleomorphism and scattered dyskeratotic keratinocytes [Figure 2] and [Figure 3] suggestive of Bowen's disease. We initiated the treatment with topical administration of 5%-fluorouracil for 6 weeks. We selected this therapy due to the ease of self-application by patients and cost-effectiveness.
Figure 1: Erythematous scaly plaque with crusting on palm.

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Figure 2: Hyperkeratosis with irregularly thickened epidermis (H and E, ×100)

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Figure 3: Loss of polarity with nuclear atypia with dyskeratotic cells (H and E ×400)

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Bowen's disease clinically presents as a solitary, slowly enlarging, erythematous, scaly papule or plaque on sun-exposed or non-sun-exposed skin. The borders are most often sharply marginated, but may be irregular. In other presentations, the central portion of the lesion may be more hyperkeratotic and have a heaped-up appearance. Bowen's disease usually affects older people and predominantly occurs on sun-exposed sites. [2] However, it may occur on areas not exposed to the sun as well, eg, genitalia. Palms and soles involvement is rarely seen. Very few cases have been reported worldwide about the occurrence of Bowen's disease on the volar skin. [3],[4]

Sunlight and exposure to arsenic are considered as the important predisposing factors. When Bowen's disease occurs on the non-sun-exposed sites and or palms or soles, the possibility of chronic arsenicosis should be ruled out. In our case, the patient was not from an arsenicosis endemic area, but on enquiring gave a history of frequent contact with fertilizers during her work. Some of the phosphate fertilizers are known to contain small amounts of arsenic. Because of economical constraints, we were unable to further investigate our patient to determine arsenic levels in her body. However, we suspect arsenic exposure through fertilizer as a cause of Bowen's disease occurring on the palm in this relatively young patient. [5] Bowen's disease occurring on the palms or soles is rare and can mimic psoriasis, lichen planus or contact dermatitis and we also need to keep infective etiology such as tinea manuum, subcutaneous mycoses (chromoblastomycosis) and cutaneous tuberculosis as differential diagnosis for Bowen's disease. Lack of satisfactory response to adequate treatment measures in such cases should arouse a suspicion of Bowen's disease and a skin biopsy should be done to rule out Bowen's disease. As fertilizers, pesticides, and other chemicals may contain arsenic, a meticulous history related to possible arsenic exposure should be sought.

 
   References Top

1.Binet O, Beltzer-Garelli E, Elbaz JS. Bowen's disease and squamous cell carcinoma of the palm. Dermatologica 1980;161:285-7.   Back to cited text no. 1
    
2.Kossard S, Rosen R. Cutaneous Bowen's disease: An analysis of 1001 cases according to age, sex and site. J Am Acad Dermatol 1992;27:406-10.   Back to cited text no. 2
[PUBMED]    
3.Fenske NA, Waisman M, Espinoza CG. Bowen's disease of the palm. Cutis 1983;31:673-7.  Back to cited text no. 3
[PUBMED]    
4.Jacyk WK. Bowen's disease of the palm: Report of a case in an African. Dermatologica 1980;161:285-7.   Back to cited text no. 4
[PUBMED]    
5.Ghosh P, Roy C, Das NK, Sengupta SR. Epidemiology and prevention of chronic arsenicosis: An Indian perspective. Indian J Dermatol Venereol Leprol 2008;74:582-93.  Back to cited text no. 5
[PUBMED]  Medknow Journal  


    Figures

  [Figure 1], [Figure 2], [Figure 3]

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