[Multiple Bowen disease of the lower limbs in elderly women: a rare clinical subset involving therapeutic difficulties].
BACKGROUND
Cutaneous Bowen's disease (CBD) is a form of intraepithelial squamous cell carcinoma that usually presents as a solitary lesion. We report four similar cases of a peculiar and well-delimited clinical subset of multiple Bowen's disease seen in the lower limbs in elderly women and associated with specific therapeutic problems.


METHODS
Four women aged over 70 years presented with multiple CBD limited to the lower limbs associated with squamous cell and superficial basal cell carcinomas along with actinic keratosis. No significant aetiological factors were present apart from chronic sun exposure other than one case possibly involving immunodeficiency. The four patients were treated using photodynamic therapy, and partial clinical response and good tolerance were observed.


CONCLUSIONS
These four cases share numerous clinical similarities: elderly women, markers of chronic sun exposure, lack of other aetiological factors such as arsenic or irradiation, localization of the lesions (multiple and/or continuous layer pattern, restricted to the lower limbs in all cases) and a chronic course. The frequency of this subset is probably underestimated due to absence of biopsies or to inconclusive histology reports. Photodynamic therapy yields valuable results with a good efficacy/safety ratio compared to imiquimod or 5-fluorouracil. However, while this treatment could be considered a first-line option in multiple CBD, its therapeutic value requires more detailed evaluation.
Maury
G
G
Service de dermatologie, CHRU de Montpellier, hôpital Saint-Eloi, université de Montpellier I, 80, avenue A.-Fliche, 34295 Montpellier cedex 5, France.
Girard
C
C
Michot
C
C
Guillot
B
B
Dereure
O
O
D000368:Aged; D000369:Aged, 80 and over; D001913:Bowen's Disease / Q000150:complications* / Q000188:drug therapy; D002280:Basal Cell Carcinoma / Q000150:complications; D005260:Female; D006801:Humans; D055623:Keratosis, Actinic / Q000150:complications; D035002:Lower Extremity; D010778:Photochemotherapy; D012878:Skin Neoplasms / Q000150:complications* / Q000188:drug therapy; D013472:Sunlight / Q000009:adverse effects