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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) Clinical picture of the patient before radiotherapy treatment. B) On the day of completion of treatment. C) Two weeks after completion of treatment. D) Eight weeks after completion of treatment
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Figure 0002: A) Clinical picture of the patient before radiotherapy treatment. B) On the day of completion of treatment. C) Two weeks after completion of treatment. D) Eight weeks after completion of treatment

Mentions: She was evaluated jointly by a radiation oncologist and surgical oncologist. At presentation to us, she had complains of pain, itching, and purulent discharge from the lesion, with exacerbation of symptoms since the last 6 months. On examination, she had a 15 cm × 10 cm erythematous, hyperpigmented, crusted plaque in the superior and antero-lateral aspect of the left side of scalp with well defined irregular border and extension to forehead (Fig. 2A). No regional lymphadenopathy was noted and rest of the systemic examination was normal. Hematological parameters were normal and HIV (human immunodeficiency virus) was non-reactive. Contrast enhanced CT scan of head revealed no underlying bone erosion. Surgery was deferred in view of large lesion size, cosmetic and reconstructive issues, and patient's un-willingness. A decision was taken to treat the patient with radiotherapy after discussion with the patient and after an informed consent.


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) Clinical picture of the patient before radiotherapy treatment. B) On the day of completion of treatment. C) Two weeks after completion of treatment. D) Eight weeks after completion of treatment
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0002: A) Clinical picture of the patient before radiotherapy treatment. B) On the day of completion of treatment. C) Two weeks after completion of treatment. D) Eight weeks after completion of treatment
Mentions: She was evaluated jointly by a radiation oncologist and surgical oncologist. At presentation to us, she had complains of pain, itching, and purulent discharge from the lesion, with exacerbation of symptoms since the last 6 months. On examination, she had a 15 cm × 10 cm erythematous, hyperpigmented, crusted plaque in the superior and antero-lateral aspect of the left side of scalp with well defined irregular border and extension to forehead (Fig. 2A). No regional lymphadenopathy was noted and rest of the systemic examination was normal. Hematological parameters were normal and HIV (human immunodeficiency virus) was non-reactive. Contrast enhanced CT scan of head revealed no underlying bone erosion. Surgery was deferred in view of large lesion size, cosmetic and reconstructive issues, and patient's un-willingness. A decision was taken to treat the patient with radiotherapy after discussion with the patient and after an informed consent.

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