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Recurrent Bowen's disease of scalp treated with high dose rate surface mold brachytherapy: a case report and review of the literature.

Gandhi AK, Laviraj MA, Kashyap L, Purkait S, Sharma DN, Julka PK, Rath GK - J Contemp Brachytherapy (2014)

Bottom Line: Patient had failed topical therapy with 5% 5-florouracil, 0.1% tacrolimus and was intolerant to topical imiquimod.Alopecia in the adjacent area has resolved and the skin pigmentation has begun.Patient is satisfied with both the disease control and the cosmetic outcome of the procedure.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, All India Institute of Medical Sciences.

ABSTRACT
Our case is a 46-year-old female presenting to us with Bowen's disease of scalp since 5 years. Patient had failed topical therapy with 5% 5-florouracil, 0.1% tacrolimus and was intolerant to topical imiquimod. At presentation, she had 15 cm × 10 cm erythematous, hyperpigmented, crusted plaque with irregular border in the superior and lateral aspect of left side of scalp with extension in to forehead. Patient was treated with computed tomography based customized surface mold high dose rate brachytherapy with Iridium-192 to a dose of 35 Gy in 10 fractions (twice daily, 6 hours apart) over 5 days. Patient tolerated the treatment well and showed regression of the lesion with mild dermatitis at the end of treatment. Though dermatitis increased at 2 weeks, at 4 weeks post treatment there was near complete resolution of the lesion with adjacent alopecia. At 8 weeks after completion of the treatment, there was complete resolution of the lesion and patient was asymptomatic. Alopecia in the adjacent area has resolved and the skin pigmentation has begun. Patient is satisfied with both the disease control and the cosmetic outcome of the procedure. Our case report demonstrates successful application of surface mold high dose rate brachytherapy in the treatment of recurrent Bowen's disease of the scalp. Brachytherapy can play an important role in the management of recurrent malignant and premalignant diseases of the complex treatment sites like scalp and it's non-hesitant use should be encouraged in appropriately selected patients at the earliest.

No MeSH data available.


Related in: MedlinePlus

A) The epidermis show irregular acanthosis with loss of normal maturation pattern (H&E ×4). B) Focally the epidermal abnormality also extending into the follicular infandibulam (H&E ×10). C) Marked cellular disarray in the epidermis with no evidence of invasion (H&E ×20). D) The neoplastic cells showing moderate degree of pleomorphism and high nucleo-cytoplasmic ratio. Frequent mitotic figures are seen (arrow) (H&E ×40)
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Figure 0001: A) The epidermis show irregular acanthosis with loss of normal maturation pattern (H&E ×4). B) Focally the epidermal abnormality also extending into the follicular infandibulam (H&E ×10). C) Marked cellular disarray in the epidermis with no evidence of invasion (H&E ×20). D) The neoplastic cells showing moderate degree of pleomorphism and high nucleo-cytoplasmic ratio. Frequent mitotic figures are seen (arrow) (H&E ×40)

Mentions: A 46-year-old female presented with a non-healing, erythematous ulcer on the left side of her scalp for one year to the department of dermatology in our institute. She complained of purulent discharge from the lesion off and on, but there was no history of pain, itching or photosensitivity. No history of trauma to the local site, chronic sun exposure or any chemical exposure could be elicited. There was no history of any co-morbidities or immunosupression (history of recurrent infections, organ transplant etc.). At the time of presentation to dermatology department in 2008, a 1 cm × 1 cm erythematous lesion with erosion and purulent crust was noted on the antero-lateral aspect of the left scalp. No similar lesion or other lesion was noted in any other muco-cutaneous sites and systemic examination did not reveal any abnormality. Patient was started on fluticasone (steroid) and mupirocin (antibiotic) and the lesion resolved, but re-appeared after 3 months. At this time, she complained of itching, purulent discharge from the lesion and also burning sensation on sun exposure. Lesion size was 2.5 cm × 2.5 cm (erythematous with purulent crusting) and a skin biopsy was ordered at this point (June 2009). Skin biopsy (Fig. 1A–D) showed features consistent with diagnosis of Bowen's disease. She received topical 5% 5-florouracil (in August 2009) and had non-complete resolution of the lesion. Subsequently, the lesion progressed to a size of 5 cm × 5 cm and 0.1% topical tacrolimus was tried with minimal response. In view of recurrent nature, a repeat biopsy was done in January 2012, which again revealed same histology. She was started on 5% imiquimod, to which she developed dermatitis and could not tolerate it well. She also intermittently received steroids, antibiotics, sun protectants etc. throughout this course of treatment. In view of intolerance to therapy/non-responsiveness and progression of the lesion, she was referred to our department in July 2013.


Recurrent Bowen's disease of scalp treated with high dose rate surface mold brachytherapy: a case report and review of the literature.

Gandhi AK, Laviraj MA, Kashyap L, Purkait S, Sharma DN, Julka PK, Rath GK - J Contemp Brachytherapy (2014)

A) The epidermis show irregular acanthosis with loss of normal maturation pattern (H&E ×4). B) Focally the epidermal abnormality also extending into the follicular infandibulam (H&E ×10). C) Marked cellular disarray in the epidermis with no evidence of invasion (H&E ×20). D) The neoplastic cells showing moderate degree of pleomorphism and high nucleo-cytoplasmic ratio. Frequent mitotic figures are seen (arrow) (H&E ×40)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4300359&req=5

Figure 0001: A) The epidermis show irregular acanthosis with loss of normal maturation pattern (H&E ×4). B) Focally the epidermal abnormality also extending into the follicular infandibulam (H&E ×10). C) Marked cellular disarray in the epidermis with no evidence of invasion (H&E ×20). D) The neoplastic cells showing moderate degree of pleomorphism and high nucleo-cytoplasmic ratio. Frequent mitotic figures are seen (arrow) (H&E ×40)
Mentions: A 46-year-old female presented with a non-healing, erythematous ulcer on the left side of her scalp for one year to the department of dermatology in our institute. She complained of purulent discharge from the lesion off and on, but there was no history of pain, itching or photosensitivity. No history of trauma to the local site, chronic sun exposure or any chemical exposure could be elicited. There was no history of any co-morbidities or immunosupression (history of recurrent infections, organ transplant etc.). At the time of presentation to dermatology department in 2008, a 1 cm × 1 cm erythematous lesion with erosion and purulent crust was noted on the antero-lateral aspect of the left scalp. No similar lesion or other lesion was noted in any other muco-cutaneous sites and systemic examination did not reveal any abnormality. Patient was started on fluticasone (steroid) and mupirocin (antibiotic) and the lesion resolved, but re-appeared after 3 months. At this time, she complained of itching, purulent discharge from the lesion and also burning sensation on sun exposure. Lesion size was 2.5 cm × 2.5 cm (erythematous with purulent crusting) and a skin biopsy was ordered at this point (June 2009). Skin biopsy (Fig. 1A–D) showed features consistent with diagnosis of Bowen's disease. She received topical 5% 5-florouracil (in August 2009) and had non-complete resolution of the lesion. Subsequently, the lesion progressed to a size of 5 cm × 5 cm and 0.1% topical tacrolimus was tried with minimal response. In view of recurrent nature, a repeat biopsy was done in January 2012, which again revealed same histology. She was started on 5% imiquimod, to which she developed dermatitis and could not tolerate it well. She also intermittently received steroids, antibiotics, sun protectants etc. throughout this course of treatment. In view of intolerance to therapy/non-responsiveness and progression of the lesion, she was referred to our department in July 2013.

Bottom Line: Patient had failed topical therapy with 5% 5-florouracil, 0.1% tacrolimus and was intolerant to topical imiquimod.Alopecia in the adjacent area has resolved and the skin pigmentation has begun.Patient is satisfied with both the disease control and the cosmetic outcome of the procedure.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, All India Institute of Medical Sciences.

ABSTRACT
Our case is a 46-year-old female presenting to us with Bowen's disease of scalp since 5 years. Patient had failed topical therapy with 5% 5-florouracil, 0.1% tacrolimus and was intolerant to topical imiquimod. At presentation, she had 15 cm × 10 cm erythematous, hyperpigmented, crusted plaque with irregular border in the superior and lateral aspect of left side of scalp with extension in to forehead. Patient was treated with computed tomography based customized surface mold high dose rate brachytherapy with Iridium-192 to a dose of 35 Gy in 10 fractions (twice daily, 6 hours apart) over 5 days. Patient tolerated the treatment well and showed regression of the lesion with mild dermatitis at the end of treatment. Though dermatitis increased at 2 weeks, at 4 weeks post treatment there was near complete resolution of the lesion with adjacent alopecia. At 8 weeks after completion of the treatment, there was complete resolution of the lesion and patient was asymptomatic. Alopecia in the adjacent area has resolved and the skin pigmentation has begun. Patient is satisfied with both the disease control and the cosmetic outcome of the procedure. Our case report demonstrates successful application of surface mold high dose rate brachytherapy in the treatment of recurrent Bowen's disease of the scalp. Brachytherapy can play an important role in the management of recurrent malignant and premalignant diseases of the complex treatment sites like scalp and it's non-hesitant use should be encouraged in appropriately selected patients at the earliest.

No MeSH data available.


Related in: MedlinePlus