Derm Dx: Erythematous Plaque With Central Scale on the Calf - Clinical Advisor

Derm Dx: Erythematous Plaque With Central Scale on the Calf

Slideshow

  • Slide

A 70-year old man presents for evaluation of an asymptomatic rash on his leg that he first noted several months ago. He denies history of systemic disease or skin cancer. Examination reveals a well-demarcated, erythematous plaque with central scale on his right lateral upper calf.

Can you diagnose this condition?

Biopsy of the lesion revealed Bowen disease, and the lesion was excised. Bowen disease is considered an in situ variant of squamous cell carcinoma.1  The condition was first described in 1912 by the American dermatologist John Templeton Bowen.2 The majority...

Submit your diagnosis to see full explanation.

Biopsy of the lesion revealed Bowen disease, and the lesion was excised.

Bowen disease is considered an in situ variant of squamous cell carcinoma.1  The condition was first described in 1912 by the American dermatologist John Templeton Bowen.2 The majority of cases are found on areas exposed to sunlight such as the scalp and extremities. The neoplasm manifests as a gradually enlarging, well-circumscribed, erythematous-to-pink patch or plaque with scale. For cases in early stages, the differential diagnosis includes psoriasis and eczema. If left untreated, Bowen disease may continue to enlarge, although <5% of cases become invasive.3

Treatment modalities for Bowen disease include topical 5‐fluorouracil and imiquimod cream, cryotherapy, curettage, photodynamic therapy, radiotherapy, laser therapy, and surgical excision.1,4

Stephen Schleicher, MD, is director of the DermDox Center for Dermatology, as well as an associate professor of medicine at Commonwealth Medical College and a clinical instructor of dermatology at Arcadia University and Kings College.

References

1. Morton CA, Birnie AJ, Eedy DJ. British Association of Dermatologists’ guidelines for the management of squamous cell carcinoma in situ (Bowen’s disease) 2014.  Br J Dermatol. 2014;170(2):245–260

2. Arora H, Arora S, Shah V, Nouri.  John Templeton Bowen. JAMA Dermatol. 2015;151(12):1329.

3. Kao GF. Carcinoma arising in Bowen’s disease. Arch Dermatol. 1986;122(10):1124–1126

4. Bath-Hextall FJ, Matin RN, Wilkinson D, Leonardi-Bee J. Interventions for cutaneous Bowen’s disease. Cochrane Database Syst Rev. 2013;(6):CD007281.

Next hm-slideshow in Derm DX