title: Recurrent Bowen's disease of scalp treated with high dose rate surface mold brachytherapy: a case report and review of the literature.
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.
authors.affiliation: Department of Radiation Oncology, All India Institute of Medical Sciences.
authors.forename: Ajeet Kumar
authors.initials: AK
authors.lastname: Gandhi
authors.affiliation: Medical Physics, Department of Radiation Oncology, All India Institute of Medical Sciences.
authors.forename: Macharla Anjaneyulu
authors.initials: MA
authors.lastname: Laviraj
authors.affiliation: Department of Radiation Oncology, All India Institute of Medical Sciences.
authors.forename: Lakhan
authors.initials: L
authors.lastname: Kashyap
authors.affiliation: Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
authors.forename: Suvendu
authors.initials: S
authors.lastname: Purkait
authors.affiliation: Department of Radiation Oncology, All India Institute of Medical Sciences.
authors.forename: Daya Nand
authors.initials: DN
authors.lastname: Sharma
authors.affiliation: Department of Radiation Oncology, All India Institute of Medical Sciences.
authors.forename: Pramod Kumar
authors.initials: PK
authors.lastname: Julka
authors.affiliation: Department of Radiation Oncology, All India Institute of Medical Sciences.
authors.forename: Goura Kishor
authors.initials: GK
authors.lastname: Rath
keywords: Bowen's disease; brachytherapy; radiation therapy; scalp
references.citation: Strahlenther Onkol. 2007 Apr;183(4):211-4
references.pmid: 17406803
references.citation: Br J Dermatol. 1987 Dec;117(6):715-20
references.pmid: 3426952
references.citation: Arch Dermatol. 1961 Oct;84:623-9
references.pmid: 14485715
references.citation: J Am Acad Dermatol. 2001 Mar;44(3):462-70
references.pmid: 11209116
references.citation: Arch Dermatol. 1983 Mar;119(3):243-60
references.pmid: 6297414
references.citation: Clin Exp Dermatol. 1999 Jul;24(4):338-9
references.pmid: 10457144
references.citation: Arch Dermatol. 2006 Jun;142(6):729-35
references.pmid: 16785375
references.citation: Br J Radiol. 1989 Jul;62(739):608-12
references.pmid: 2758248
references.citation: J Contemp Brachytherapy. 2014 Jun;6(2):167-72
references.pmid: 25097557
references.citation: Br J Dermatol. 1995 Jul;133(1):60-5
references.pmid: 7669642
references.citation: J Contemp Brachytherapy. 2013 Mar;5(1):45-9
references.pmid: 23634155
references.citation: Strahlenther Onkol. 2013 Oct;189(10):894-8
references.pmid: 23963206
references.citation: Int J Radiat Oncol Biol Phys. 2005 Oct 1;63(2):505-10
references.pmid: 16168842
references.citation: Arch Dermatol. 1999 Jul;135(7):790-3
references.pmid: 10411153
references.citation: J Am Acad Dermatol. 2001 Sep;45(3):401-4
references.pmid: 11511838
references.citation: Rev Recent Clin Trials. 2012 Feb;7(1):42-6
references.pmid: 21864250
references.citation: Arch Dermatol. 1986 Oct;122(10):1124-6
references.pmid: 3767398
references.citation: J Am Acad Dermatol. 2006 Jun;54(6):1025-32
references.pmid: 16713457
references.citation: J Am Acad Dermatol. 2006 Aug;55(2):324-7
references.pmid: 16844522
references.citation: Int J Radiat Oncol Biol Phys. 2000 Apr 1;47(1):95-102
references.pmid: 10758310
references.citation: Br J Dermatol. 2014 Feb;170(2):245-60
references.pmid: 24313974
references.citation: Br J Dermatol. 2003 Mar;148(3):539-43
references.pmid: 12653747
references.citation: J Med Imaging Radiat Oncol. 2013 Apr;57(2):212-7
references.pmid: 23551783
references.citation: Eur J Nucl Med. 2000 Jul;27(7):842-6
references.pmid: 10952496
references.citation: Radiother Oncol. 2009 May;91(2):255-60
references.pmid: 18954915