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Background: Feline Bowenoid in situ carcinoma (BISC) is frequently associated with Felis catus papillomavirus-2 (FcaPV-2). Although surgical excision of BISC is expected to be curative, recurrent lesions are reported and it is not known whether it is a consequence of incomplete surgery or residual viral load., Objectives: To combine colorimetric in situ hybridisation (CISH) and quantitative (q)PCR for the detection of viral DNA, and to correlate the clinical outcome of cats with BISC in which FcaPV-2 DNA is detected at surgical margins., Animals: Twenty-seven cats with a histopathological diagnosis of BISC., Materials and Methods: Sections including core and margins of the lesions were used for histopathological evaluation, qPCR and CISH. After surgical removal of the lesion, clinical follow-up data were recorded for 6 months., Results: Six of 12 cases in which all four histological margins were evaluable were used to correlate the infection status at the margins with the follow-up data. Four showed margin positivity, of which half relapsed as expected and half cured; two cases were negative, of which one cured as expected while the other relapsed. Fifteen cases where only three, two or one of the histological margins were evaluable, were considered to adequately correlate the status of infection with the follow-up data if CISH was positive. Follow-up data were available for three with positive margins: one relapsed while the other two were cured., Conclusions and Clinical Relevance: Wide clinical surgical margins are always recommended for neoplastic conditions, yet there was no evidence that CISH margin examination would be beneficial in predicting recurrence in this viral-induced lesion., (© 2024 ESVD and ACVD.)

We present a rare case of clonal seborrheic keratosis (SK) with focal Bowen disease (BD) (squamous cell carcinoma in situ) accompanied by sebaceous differentiation. An 89-year-old woman presented with a pale reddish-brown plaque on the left buttock. Histopathological examination of the excisional specimen revealed hyperkeratosis, acanthosis, and intraepidermal epithelioma. In some areas of the tumor, we observed proliferation of basaloid keratinocytes within the intraepidermal nests and pseudohorn cysts. This area was diagnosed as clonal SK. However, in other areas, the tumor cells within the intraepidermal nests showed nuclear pleomorphism, abnormal mitoses, dyskeratotic cells, and clumping cells, consistent with BD with a nested/clonal pattern (clonal BD). The SK and BD areas were contiguous with the transitional zone. Some nests within the BD area contained vacuolated cells with bubbly cytoplasm and scalloped nuclei, suggestive of sebaceous differentiation. Therefore, we made the diagnosis of clonal BD with sebaceous differentiation arising from clonal SK. All areas contained intraepidermal nests, which revealed that the lesions were not the result of accidental collision, but that the neoplastic cells in the intraepidermal nests of the SK transformed into BD and underwent sebaceous differentiation., (© 2024 Japanese Dermatological Association.)

Mohs micrographic surgery is the gold standard for treating many types of skin cancer, particularly skin cancers of high-risk areas such as the face, genitalia, and digits, due to its tissue-sparing technique and low recurrence rates. The use of Mohs micrographic surgery for human papilloma virus-associated cutaneous malignancies has yet to be explored in a systematic review. The authors sought to assess outcomes including recurrence rates of Mohs micrographic surgery for human papilloma virus-associated cutaneous malignancies. PubMed was searched for the use of Mohs micrographic surgery in types of human papilloma virus-associated cutaneous malignancies. After application of exclusion and inclusion criteria, 33 articles were included. 700 cases from 33 studies were included. Overall recurrence rate following Mohs micrographic surgery was 39/478 (8.2%) at a mean follow-up time of 51.5 months. Recurrence rate for nail unit/digit squamous cell carcinoma was 10/103 (9.7%) at mean follow-up of 47.6 months. Recurrence rate for penile squamous cell carcinoma was 15/181 (8.3%) at mean follow-up of 45.9 months. Recurrence rate for Bowen's disease in extragenital areas was 11/189 (5.9%) at mean follow-up of 59.7 months. Patients overall reported satisfactory functional and cosmetic results. Mohs micrographic surgery demonstrates low recurrence rates and excellent functional and cosmetic outcomes in the treatment of human papilloma virus-associated cutaneous malignancies., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Human papillomavirus (HPV) is a common sexually transmitted infection with wide-ranging clinical manifestations. High-risk anogenital HPV genotypes have also been reported to cause extragenital disease. We describe the case of a 69-year-old male patient living with HIV who was diagnosed with HPV-16 associated Bowen's Disease (BD) of the right middle finger nailbed, despite good virologic control and immune reconstitution. The lesion was managed surgically with adjunctive post-exposure HPV vaccination. This case adds to the growing body of evidence of extra-genital HPV disease attributable to anogenital genotypes in people living with HIV., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Randomized controlled trials comparing the effectiveness of 5-fluorouracil cream, methylaminolevulinate photodynamic therapy (MAL-PDT) and surgical excision in patients with Bowen's disease are lacking., Methods: In this multicenter noninferiority trial, patients with a histologically proven Bowen's disease of 4-40 mm were randomly assigned to excision with 5 mm margin, 5% 5-fluorouracil cream twice daily for 4 weeks, or 2 sessions of MAL-PDT with 1 week interval. The primary outcome was the proportion of patients with sustained clearance at 12 months after treatment. A noninferiority margin of 22% was used., Results: Between May 2019 and January 2021, 250 patients were randomized. The proportion of patients with sustained clearance was 97.4% (75/77) after excision, 85.7% (66/77) after 5-fluorouracil, and 82.1% (64/78) after MAL-PDT. Absolute differences were -11.7% (95% CI -18.9 to -4.5; P = .0049) for 5-fluorouracil versus excision and -15.4% (95% CI -23.1 to -7.6; P = .00078) for MAL-PDT versus excision. Both noninvasive treatments significantly more often led to good or excellent cosmetic outcome., Conclusions: Based on our predefined noninferiority margin of 22%, 5-fluorourcail is noninferior to excision and associated with better cosmetic outcome. For MAL-PDT noninferiority to excision cannot be concluded. Therefore, 5-fluorouracil should be preferred over excision and MAL-PDT in treatment of Bowen's disease., Competing Interests: Conflicts of interest None disclosed., (Copyright © 2023 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Keratinocyte skin carcinomas (squamous cell carcinoma, basal cell carcinoma [BCC], Bowen disease [BD]) inflict significant morbidity and constitute a treatment challenge in renal transplant recipients (RTR). Immunocryosurgery has shown efficacy >95% in the treatment of BCC and BD in immunocompetent patients. The present study evaluated the safety, feasibility and efficacy, of immunocryosurgery in the treatment of BCC and BD in a series of RTR. During a 3-year period, biopsy-confirmed cases of BCC and BD were treated with a standard immunocryosurgery cycle (5 weeks daily imiquimod and a session of cryosurgery at day 14). Safety was evaluated by comparing graft function markers between immunocryosurgery treated RTR patients and matched controls. Ten BCC (8 nodular, 1 basosquamous, 1 superficial; diameter 6-14 mm; mean 9.2 mm) and nine BD disease lesions in nine patients (7 men, 2 women; age range: 54-70 years, mean: 62.1 years) were treated with immunocryosurgery and followed-up for two to 5 years. Five BCC were located on the "H area" of the face. No patient showed clinical or laboratory signs of transplant dysfunction during treatment or follow-up. Seven out of 10 BCC lesions cleared completely after one 5-week immunocryosurgery cycle, two cleared after repeat and intensified treatment cycles and one responded only partially (clearance rate: 90%). Seven out of nine BD lesions cleared after one 5-week immunocryosurgery cycle and one lesion after two cycles (clearance rate: 88.9%). In conclusion, immunocryosurgery is a safe, feasible and effective minimally invasive treatment alternative to standard surgical modalities for BCC and BD in RTR., (© 2022 Wiley Periodicals LLC.)

Background: Surgery is the mainstay of treatment for non-melanoma skin cancer. Lasers are an additional option., Objective: The objective of this study was to review the literature on the efficacy and safety of lasers for the treatment of non-melanoma skin cancer., Methods: A systematic review and meta-analysis of laser treatment for non-melanoma skin cancer was performed. The primary outcome was recurrence rate (RR)., Results: The review included 32 studies (six randomized controlled trials and 26 cohort studies): 27 evaluated basal cell carcinomas (BCCs), three squamous cell carcinomas, and two both, for a total of 4755 BCCs and 214 squamous cell carcinoas. Most BCCs were low risk. The Nd:YAG laser (seven studies, 3286 BCCs) had a 3.1% RR (95% confidence interval [CI] 1.4-6.4%) during a mean follow-up of 7.9 years, with a low rate (< 20%) of scarring and dyspigmentation. The CO 2 laser (ten studies, 904 BCCs) had a 9.4% RR (95% CI 4.1-20) during a mean follow-up of 2.1 years, with a low rate of side effects. The pulsed dye laser (eight studies, 206 BCCs) had a 38% RR (95% CI 24-55). In two studies, the Nd:YAG laser demonstrated a RR of 10% (95% CI 2-31) for Bowen's disease, and in three studies, the CO 2 laser demonstrated a RR of 22% (95% CI 5-61) for squamous cell carcinoma., Conclusions: Based on cohort studies, the Nd:YAG laser is a safe and efficacious modality for the treatment of low-risk BCC. Based on settings applied in prior studies in the literature, the CO 2 laser is less efficacious than the Nd:YAG laser, thus it cannot be recommended for BCC treatment. Insufficient data preclude conclusions regarding laser treatment for squamous cell carcinoma., Registration: PROSPERO registration number CRD42019129717.

Matrical differentiation is the distinctive feature of pilomatricoma and other purely matrical adnexal neoplasms; additionally, foci of matrical differentiation have been also described in hybrid cysts of Gardner syndrome, as well as in a wide variety of benign and malignant cutaneous tumors, including basal cell carcinoma. We report an exceptional case of Bowen disease exhibiting multiple foci of matrical differentiation, as confirmed by means of immunohistochemical studies. Several types of divergent, non-squamous differentiation have been exceptionally reported in cutaneous squamous cell carcinoma in situ (cSCCIS), including sebaceous, mucinous/glandular, poroid, tricholemmal, and neuroendocrine differentiation; matrical differentiation may be added to this list. Our findings further emphasize the undifferentiated nature of neoplastic cells in cSCCIS., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Merkel cell carcinoma (MCC) is a rare, aggressive primary cutaneous neuroendocrine cancer which almost always exhibits the cytokeratin (CK)20+/thyroid transcription factor (TTF)-1- immunophenotype. MCC may occur concurrently with squamous cell carcinoma, Bowen disease, and/or basal cell carcinoma (BCC), with some evidence that MCCs which occur in conjunction with other neoplasms exhibit different immunophenotypes compared to pure MCC cases. We present a case of CK20-/TTF-1+ MCC concurrent with Bowen disease and BCC, and discuss possible differences in the pathogenesis of pure vs combined MCC. We also review the literature for this unusual immunophenotype, noting that most cases occur in combined MCC., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Here, we report the case of cutaneous metastases from testicular diffuse large B-cell malignant lymphoma (DLBCL) concurrent with Bowen disease evaluated with 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT). A 60-year-old male underwent orchiectomy to remove his left testicle because of DLBCL. Multiple skin lesions appeared 1 month postoperatively. Furthermore, an intractable erythematous plaque localized to the right lower leg was present from 2 years before the operation. 18F-FDG PET-CT images revealed multiple skin lesions with marked FDG uptakes in the face, neck, and thigh of this patient, as well as a lower leg lesion with minimal FDG uptake. Biopsy of both lesions revealed cutaneous metastases from DLBCL and Bowen disease (BD) of the lower leg lesion. 18F-FDG PET-CT images following chemotherapy and resection of BD demonstrated no FDG uptake.

A wide range of therapeutic options are available for the treatment of Bowen disease. However, few studies have been conducted on wide excision using various resurfacing methods. The objectives of this study were:One hundred forty-eight lesions were studied. All lesions were histopathologically confirmed as Bowen disease. Lesions were classified by anatomical site and treatment modality and their dimensions were measured. Punch biopsy was reperformed when a treated lesion was considered to have possibly recurred. Recurrence rates were then compared. Preoperative and intraoperative photos and follow-up images were also taken.The most common site of Bowen disease was the head and neck region. Wide excision was found to provide good outcomes with minimal tumor recurrence. Recurrence after cryotherapy occurred relatively quickly (mean 0.2 years, median 0.2 years) while recurrence after wide excision occurred at a mean 2.5 years. Treatment modality was significantly associated with recurrence (P < .05).The optimal treatment for Bowen disease has not been determined. Wide excision provided lower recurrence than other treatment modalities. Providers should be aware of the multiple treatment options available and select the method most appropriate for each patient. The limitations of our study are that it was retrospectively designed and conducted at a single institution.

Introduction: Bowen's disease or squamous cell carcinoma in situ is a precursor malignant neoplasm restricted to the epidermis. Clinically and histologically, Bowen's disease of the nipple can resemble Paget's disease. It is crucial to differentiate between the two with immunohistological staining in order to provide the appropriate treatment. This review of Bowen's disease of the nipple will examine the diagnostic and treatment modalities previously used. We also present our own case of Bowen's disease of the nipple and propose a clinical pathway for this rare disease process., Methods: A review of published literature using MEDLINE, PubMed, and Google Scholar revealed seven articles were identified with a total of eight cases of Bowen's disease of the nipple., Results: Treatment modalities varied within the literature. This ranged from photodynamic therapy to simple mastectomy and sentinel lymph node biopsy. Standard surgical margins are inadequate for Bowen's disease of the nipple, as it has been shown to spread along the lactiferous ducts. Our case is of a 57-year-old female with Bowen's disease of her right nipple, confirmed through immunohistological staining. Wide local excision with immediate full-thickness skin graft reconstruction was performed and is now disease-free with a healed graft., Conclusion: There is no accepted management pathway for Bowen's disease of the nipple. We propose a treatment algorithm that involves immunohistological staining to diagnose Bowen's disease of the nipple. This would then be followed by a wide local excision, complete nipple excision including underlying lactiferous ducts and glandular tissue and subsequent reconstruction., (© 2020 Wiley Periodicals, Inc.)

Objective: We aimed to explore the efficacy of keystone flap combined with vacuum-assisted closure (VAC) in the repair of sacrococcygeal wounds., Methods: This study is a retrospective review of patients undergoing keystone flap reconstruction between January 2014 and January 2018. A standardized data collection template was used to collect related variables. The detailed process of the reconstructive surgery is carefully described in this study. The postoperative healing process was closely observed., Results: Twelve patients underwent keystone flap repair between January 2014 and January 2018. The average wound size before closure measured 7.83 ± 1.93 × 5.28 ± 0.91 cm. All the patients achieved primary wound healing and the flaps survived during the follow-up period, which ranged from 1 to 24 months. No severe complications and obvious scar appeared, and the patients were satisfied with both appearance and function., Conclusions: The application of keystone flap combined with VAC is a promising way to repair wounds in the sacrococcygeal region with little postoperative complication and similar soft-tissue thickness to the surrounding tissue., (© 2019 Wiley Periodicals, Inc.)

Background: Centrosomes contain two centrioles: a pre-existing mature centriole and a newly formed immature centriole. Each centriole is duplicated once within a cell cycle, which is crucial for proper centrosome duplication and cell division., Objective: To describe the centrosome duplication cycle in human epidermis, Bowen's disease (BD), and squamous cell carcinoma (SCC)., Methods: Immunofluorescent staining of centriolar proteins and Ki-67 was used to evaluate cell cycles and the number of centrioles. Centrobin and Outer dense fiber of sperm tails 2 (ODF2) were used as markers for immature and mature centrioles, respectively., Results: Normal human primary epidermal keratinocytes in a monolayered culture have one centrobin + centriole (CTRB 1+ cells) supposed in G0/G1 phases or have two centrobin + centrioles (CTRB 2+ cells) supposed in S-G2 phase. In a three-dimensional culture and in vivo human epidermis, the majority of suprabasal cells were CTRB 2+ cells, in spite of their non-proliferative Ki-67 - nature. The tumor mass of BD and SCC contained CTRB 1+ cells and Ki-67 + proliferating and Ki-67 - non-proliferative CTRB 2+ cells. Clumping cells in BD had increased numbers of centrioles, with an approximate 1:1 to 2:1 ratio of centrobin + to ODF2 + centrioles., Conclusions: The cell cycle arrest of suprabasal cells is distinct from the G0 arrest of monolayered epithelial cells. Tumor mass of BD and SCC contained non-proliferative cells with the characteristics of the suprabasal cells of normal epidermis. A constant ratio of the number of centrobin + to ODF2 + centrioles indicates that multiple centrioles were induced by cell division failure rather than centriole overduplication in clumping cells., (Copyright © 2018. Published by Elsevier B.V.)

Introduction: Here we present the case of a 56-year-old human immunodeficiency virus (HIV)-infected man with multiple anal condylomas and positivity for human papilloma virus (HPV) 18 on anal brushing. Biopsies of the anal mucosa led to the diagnosis of Bowen's disease and a subsequent pelvic magnetic resonance imaging (MRI) scan evidenced multiple reactive lymphoadenopathies and large intra-anal condylomas. The patient was treated with a complete excision of Bowen's lesion and with a 4 months course of supplementation with a high concentration multistrain probiotic formulation administered orally and by rectal instillation with the purpose to reduce local inflammation and to enhance local mucosal immunity., Conclusion: An MRI performed at the end of the supplementation period evidenced the clearance of the anal condylomas previously described and no evidence of residual lymphadenopathies. Trials are therefore required to confirm this therapeutic possibility and for a better understanding of the mechanisms by which this specific probiotic formulation interacts with local epithelium when administered by the anal route.

We here report the case of a16-year old patient, with no particular past medical history, presenting, with skin swelling at the level of the forefoot evolving for 02 years, at the Department of Dermatology. Clinical examination showed hard budding cutaneous mass painless on palpation covering the 2 nd , the 3 rd and the 4 th , right toes, measuring 4 cm in large diameter. The remainder of the clinical examination was normal, without adenopathies. Skin biopsy was performed at the level of the tumor and histological examination showed carcinoma in situ. Surgical treatment was recommended. Bowen's disease is a relatively rare squamous intraepithelial carcinoma in situ. It mainly affects adults at any age, with predominance in women. The diagnosis is suspected on the basis of clinical examination, but it is confirmed by the anatomo-pathological examination.

Background: Bowen's disease is an intraepithelial tumor, also known as squamous cell carcinoma in situ. Among those alternative treatments, PDT usually produce better cosmetic outcomes compared with those of 5-fluorouracil and cryosurgery., Methods: Before the applications of photosensitizer, epidermis of the lesions were totally ablated by fractional CO2 laser (eCO2®, Lutronic, Korea) with the following parameters: tip size 120 μm, peak power 30 W, pulse energy 50 mJ, 200 spots/cm 2 . After the ablation of epidermis, methyl aminolevulinate (MAL) (Metvix®, Galderma, France) was applied with incubation time of 90 minutes followed by light exposure. 630 nm light from Aktilite CL 128® (Galderma, Switzerland) was utilized at a light dose of 37 J/cm 2 . The clinical improvement of the lesion was evaluated either as a complete response (CR, complete absence of lesion), a partial response (PR, 25∼99% reduction in lesion) or no response (NR, 0∼24% reduction in lesion)., Results: The treatment result was excellent (87.5% of clinical CR). No scar formation after the treatment was noted in 7 patients who achieved clinical CR., Conclusions: Total ablation of epidermis before PDT can enhance the treatment efficacy of PDT without adverse events in the treatment of Bowen's disease., (Copyright © 2017. Published by Elsevier B.V.)

Laissez-faire following excision of peri-ocular tumours has been described, but is not universally well established. We describe our experience with laissez-faire for managing medial canthal defects following tumour excision and compare our outcomes with full thickness skin grafts. Retrospective comparative case series of 68 patients who underwent reconstruction of a medial canthal defect using laissez-faire with sutured Sorbsan (LFS) (n = 36) or a full thickness skin graft (FTSG) (n = 32) at the same centre. Tumour diagnosis, defect size, time taken to epithelialise, functional and cosmetic outcomes, complications, follow-up duration and any secondary interventions were recorded. Basal call carcinoma was the most common neoplasm excised (63/68, 93%). Defect size ranged from 7 × 5 mm to 25 × 10 mm. Mean time for wound epithelialisation in LFS group was 33 days. Mean duration of follow-up was 32 months (range 1-80 months) for LFS and 30 months (range 6-60 months) for FTSG. Good functional and cosmetic outcomes were achieved in all 68 patients. Review of clinical photographs showed epicanthic fold in 2 patients and visible scar in 1 patient in the LFS group and 3 cases of hypopigmented scar and 7 hypertrophic scars in the FTSG group. No cases required secondary intervention. There were no cases of postoperative infection. LFS in the medial canthal region is less likely to lead to hypertrophic scarring or cicatricial sequelae compared to FTSG (p = 0.02). Both techniques are associated with excellent functional and aesthetic outcomes even for larger defects.

How to close skin defects is one of the most important considerations for skin surgeons. Rhomboid flaps are used for many types of skin defect. Such flaps, represented by the Limberg and Dufourmentel flaps, are widely used at any region of the body because they are composed of straight lines and are easy to draw. However, these valuable techniques have the disadvantage of being prone to dog-ears at a particular area of the flap. Therefore, our talented predecessors have modified these flaps in order to resolve the problems. The modified flaps they designed were difficult to draw because the modified designs were curvy and along esthetic lines. It is difficult for trainees to draw these flaps. To address this issue, we have developed newly modified rhomboid flaps that are based on the Dufourmentel flap. This flap is different from the Dufourmentel flap in omitting the top half of the diamond above the circle. Thus, the tension on the skin decreases and dog-ears are less likely to occur. In addition, our flaps are geometric and easily drawn even by novices. We believe our flap will be a promising option for closing skin defects at any site., (© 2016 Japanese Dermatological Association.)

Bowen's disease (BD)/carcinoma is a type of squamous cell carcinoma of the skin, however, the possibility of adnexal differentiation (the development of sebaceous carcinoma or porocarcinoma) occurring in BD/carcinoma has been suggested. We herein describe a case of BD with superficial invasive carcinoma, which showed a clear cell focus, demonstrating tricholemmal differentiation. This clear cell focus showed the following findings: primarily composed of clear cells, somewhat columnar clear cells aligned in a palisade along a discernible basement membrane, tricholemmal keratinization and glycogen contained within the cells. In addition, the immunohistochemical profile in this clear cell focus, namely, negative staining for cytokeratin (CK)1 and positive staining for CK17 and calretinin in the inner cells of the neoplastic lobule, corresponded to that of the outer root sheath cells. This case suggested that adnexal differentiation can rarely occur within true BD/carcinoma, although adnexal carcinomas are commonly associated with a simple bowenoid change., (© 2015 Japanese Dermatological Association.)

Objective: To summarize the clinical application of the lobulated flap or unilobular flap pedicled with the descending branch of lateral femoral circumflex artery in reconstruction of defects resulted from perineal and hypogastric tumor resection., Methods: From September 2010 to June 2014,according to the characteristics of the tissue defects after perineal or hypogastric tumor resection, and also based on the anatomical characteristics of the perforator artery which derived from the descending branch of lateral circumflex artery, unilobular skin flap or bilobulate skin flap was designed for one-stage reconstruction.7 males and 10 females, aged from 34 to 72 years old (average,56 years old), were included. There were 6 cases of dermatofibrosarcoma protuberance (DFSP),7 cases of squamous-cell carcinoma and 4 cases of Bowen disease. Tumors in 7 patients were located in hypogastrium and 10 in perineum. The defects size after tumor resection ranged from 3 cm × 4 cm to 8 cm × 16 cm. Among the patients,13 cases were treated with unilobular flaps, of which the area ranged from 6 cm × 10 cm to 13 cm × 18 cm;4 cases were treated with bilobular flaps, of which the area ranged from 3 cm ×5 cm to 8 cm ×12 cm.The wounds at donor sites were closed directly in 13 patients, and covered with skin graft in 4 patients. All patients underwent tumor extensive resection and subsequently reconstruction with flaps. The clinical courses ranged from 3 to 24 months., Results: All the flaps survived without vascular crisis. The wounds and incisions at donor sites healed primarily.12 patients were followed up for 3 to 26 months. The average follow-up duration was 16 months.During the follow-up period, the flaps were in good color and texture. Furthermore, patients were satisfied with vulvar appearance and even their sex life.Local tumor recurrence was not observed during the follow-up period., Conclusion: The flap pedicled with the descending branch of lateral femoral circumflex artery has a relatively long vascular pedicle, which may meet the requirement for reconstruction of defects in perineal and hypogastric region. Moreover, this flap could be designed as lobulated flap to repair two wounds at one-stage.This flap is an ideal option for reconstruction of perineal and hypogastric soft tissue defects with a reliable blood supply and unobvious donor sites.

Bowen's disease of the nail apparatus is uncommon. Since often characteristic clinical features are missing, diagnosis and treatment are delayed. We have analyzed our patients' files from January 2001 to July 2015 for this disorder. We identified eight patients with Bowen's disease of the nail apparatus, six male and two female individuals. Fingers were more often affected than toes. The disease does not respect the anatomical borders of the nail apparatus. Therefore, we performed delayed Mohs surgery with skin grafts in seven patients and with second intention healing in one patient. Two relapses were noted but only one ate the same digit. Since relapses occurred after 2-3 years, a follow-up of such patients seems justified.

Background: Reconstructive surgery has entered a "perforator flap era" with more surgeons performing successful perforator flap procedures. The perforator-based island flap is an extension of this perforator concept and one of the most successful. In perforator-rich or -reliable areas, this allows for primary closure of the donor site and the construction of highly customized flaps with little tissue waste., Methods: The authors present a design modification of the perforator-based island flap used in 73 patients who underwent heart balloon perforator-based island flap reconstruction between 2008 and 2012., Results: There were no reported cases of total flap necrosis. Marginal necrosis of the flap was noted in three cases, which resolved with simple dressings. The donor sites were closed primarily in all cases., Conclusions: The heart balloon perforator-based island flap enables tension-free closure of the donor site, reduces donor-site complications, and minimizes tissue waste. The resulting shape resembles a heart and gives rise to the flap's name. Key principles for success are perforators close to the defect, a flap axis that allows for primary donor-site closure, flap border adjacent to the defect that is smaller than the postresection defect, flap harvest until an adequate arc of rotation is obtained, primary closure of the donor site before flap inset, and preservation of a triangular area between the proximal apex of the flap and the defect., Clinical Question/level of Evidence: Therapeutic, IV.

Pigmented Bowen's disease is a rare subtype of in situ squamous cell carcinoma of the skin and mucosa, with a potential risk of invasion and metastasis. It is universally accepted that human papillomavirus (HPV) is the cause of genital Bowen's disease. Herein we report an unusual case of pigmented Bowen's disease of the genital area that clinically simulated malignant melanoma. Accurate diagnosis could only be established after histological examination. Polymerase chain reaction (PCR) analysis showed that the lesion harbored HPV 16 DNA. Although pigmented Bowen's disease is rare, it should be considered in the differential diagnosis of all pigmented lesions of the genitalia. This case report highlights the necessity of biopsy and histopathological examination for every suspicious cutaneous lesion.

Background: Due to a rapid increase in the incidence of skin cancer, it seems inevitable that general practitioners (GPs) will play a larger role in skin cancer care., Objectives: To assess surgical procedures used by GPs in skin tumour management., Methods: We performed a retrospective study of 1,898 pathology reports of skin tumours excised by GPs in 2009., Results: In 22.9% no diagnosis was provided on the application form. Mostly, once-off excisions (no preceding biopsy) were performed, 7% of the excised lesions were malignant, and 35% of incisions were incomplete. Excisions in the face and neck region were incomplete in 65.4%; 22% of melanomas were biopsied or shaved., Conclusion: This study underlines the difficulties in skin tumour management in primary care. To stimulate adequate resource use, the number of excisions of benign lesions could be lowered, and pretreatment biopsy in non-melanoma skin cancer management should be encouraged. GPs should be aware of their limitations and consider referral of high-risk malignancies.

Background: Perianal high-grade dysplasia (Bowen disease) is traditionally treated with mapping and wide excision with possible grafting rather than local ablation., Objective: The aim of this study is to examine the results of high-grade perianal dysplasia ablation., Data Sources: Data for this study were derived from a retrospective chart review at a surgical practice screening and treating patients for high-grade dysplasia between July 1998 and June 2013., Study Selection: The patients included were men who have sex with men and are undergoing perianal dysplasia ablation., Intervention: Ablation of perianal dysplasia with electrocautery, laser, or infrared coagulation was performed., Main Outcome Measures: The primary outcomes measured were the recurrence of perianal dysplasia postablation and factors affecting recurrence., Results: Seventy HIV-positive and 11 HIV-negative patients enrolled; the median ages were 44.7 and 42.8 years. Median follow-up times for HIV-positive and HIV-negative patients were 4.62 and 3.53 years, and the median numbers of treatments were 4 and 1, p = 0.004. The median number of lesions treated was 1 for both groups. Only 1 HIV-negative patient had a recurrence 8 months after treatment. For HIV-positive patients, the Kaplan-Meier probability of recurrence at 1, 3, and 5 years was 38% (95% CI 26-50), 59% (95% CI 47-72), and 68% (95% CI 55-81) after the first ablation with no difference for subsequent treatments. HIV-positive patients had a relative risk of perianal high-grade squamous intraepithelial lesions of 3.72 (95% CI 2.10-6.60) compared with HIV-negative patients (p ≤ 0.0001). In multivariate analysis, only each increase in intra-anal high-grade squamous intraepithelial lesions significantly increased recurrence (HR 1.13, 95% CI 1.00-1.28, p = 0.002). Only 3 patients with perianal high-grade squamous intraepithelial lesions did not have canal dysplasia. Perianal cancer developed in 3 after being lost to follow-up., Limitations: This is a retrospective analysis of 1 experienced surgeon's results. No precise way exists to accurately determine the size of the disease., Conclusions: Perianal dysplasia can be successfully ablated, but recurrence remains high. Almost all patients have anal canal dysplasia. HIV-positive patients are at the greatest risk for disease and recurrence. An increased number of high-grade canal lesions increases recurrence.

Extramammary Paget's disease and Bowen's disease are histologically similar and immunohistochemistry is often required to make the diagnosis. We present a case of vulval Paget's disease with Bowen's disease in an elderly female. Strong positivity for cytokeratin 7, anti CAM 5.2, carcinoembryonic antigen (CEA) and periodic acid-Schiff (PAS) stain in clitoral, left labial and interface regions of the vulvectomy specimen confirmed the diagnosis of Paget's disease (PD) while positive staining for p63 in the right labial and interface regions helped in establishing the diagnosis of concurrent Bowen's disease (BD).

Distinctive asymmetry of the labia minora is an underestimated complication that can be congenital, post-traumatic, or occur after oncological intervention or aesthetic labioplasty. Affected women can be restricted functionally and in their sense of self-worth, aesthetic appearance and sexual life. In presenting this case of post-oncological labia minora asymmetry, we demonstrate our method of the two-stage posterior cross-labial transposition flap as a reliable technique for unilateral labium minus reconstruction.

Bowen's disease is an in situ squamous cell carcinoma of the skin with various treatment modalities available. A major advantage of surgical excision is the opportunity to histologically examine the resection margins. There is no consensus about the most appropriate margin. This retrospective study evaluates the clearance rates achieved by excision with a 5 mm margin and estimates how that might change after fictitiously reducing the resection margin by 1 or 2 mm. Patients with histologically confirmed Bowen's disease were selected at the Maastricht University Medical Centre from 2002 until 2007. Surgical margins and complete excision rates were evaluated and histological slides were re-examined. To our knowledge this is the first study investigating the safety margin for Bowen's disease. As Bowen's disease is not an invasive disease, minimisation of healthy tissue excision is desirable. Our data show that a hypothetical reduction of the safety margin from 5 mm to 4 or 3 mm decreases the complete excision rate from 94.4% to 87% and 74.1%, respectively.

Plastic surgeons reconstruct hard and soft tissues in many parts of the human body. Penile reconstruction is unique in that the target tissue has to be soft but intermittently rigid. There are many ways to treat penile defects. The ideal reconstruction must take into considerations sensation, cosmesis, and erectile functions. There is limited literature available on the management of penile glans defect. In this report, we present the reconstruction of penile glans defect, after surgical excision of Bowen disease, using a bipedicled foreskin flap of bucket handle type. It is easy to perform and highly effective, and importantly, both cosmetic and functional outcomes at 1-year follow-up were quite satisfactory.

Incidence of skin tumors is increasing among elderly patients, and the multi-morbidities which occur in the elderly are a great challenge for dermatologists. Basis of every treatment of skin cancer patients is a reliable diagnosis. Therefore, histopathology serves as the gold standard in clinical dermatooncology and dermatologic surgery. This chapter provides a comprehensive review on the main types of melanoma and nonmelanoma skin cancers, including precursor lesions.

Objective: To analyse the clinical and pathological characteristics, diagnosis, treatment and prognosis of vulvar Bowen's disease., Methods: Clinical data including pathological characteristics, diagnosis, treatment methods and follow-up of 18 cases with vulvar Bowen's disease admitted to Cancer Hospital, Chinese Academy of Medical Sciences during January 1991 to June 2011 were retrospectively analyzed., Results: The median age of the 18 patients was 37 years (range:23 to 64 years) . Sixteen patients had symptoms of vulvar itching and two patients had no symptom. Five cases were single neoplasm focus and the other 13 cases were multiple focuses. The diagnosis of vulvar Bowen's disease was according to the pathological diagnosis. Its diagnostic characteristic was giant round or ovoid cells with mono nucleolus in the whole layer of epidermis. All the patients received operation, eleven with simple vulvectomy and other seven cases with lumpectomy. The median follow-up time was 123 months (range: 5 to 197 months). Relapse was found in two cases. One patient relapsed five months postoperation and received vulvectomy. Another patient relapsed fifteen moths post-operation and received lumpectomy again. And they were follow-up for 192 months and 55 months respectively after second operation without relapse., Conclusions: The diagnostic characteristic of vulvar Bowen's disease is giant round or ovoid cell with mono nucleolus in the whole layer of epidermis, itsdiagnosis is according to the pathological diagnosis. Operation could get very good curative effect for patients with primary vulvar Bowen's disease and even for the recurrent patients. The prognosis of vulvar Bowen's disease is good.