title: Giant extragenital Bowen's disease.
abstract: Giant extragenital forms of Morbus Bowen are extremely rare. The already described cases in the word literature are most commonly with periungual localization, as well as located on the foot and neck area. The clinical manifestation is presented most commonly by non-specific erythematous to erythematous-squamous plaques or papules, which is confusing to the clinician. From the pathogenic point of view, it is important to be confirmed or rejected the presence of human papilloma viruses (HPVs) in each case of affected patient, as this information is mandatory in respect to the adequate selection of the subsequent regimen. If HPVs are detected, systemic antiviral therapy could be initiated to reduce the size of the lesions before subsequent surgical eradication. A postoperative prevention through vaccination could be also considered additionally. In cases of HPV-negative giant extragenital forms of Morbus Bowen (as in the described patient), the focus should be on local immunomodulation by substances such as imiquimod, which reduce the size of the lesions, thereby creating optimal opportunities for their future surgical eradication. Other possible options described in the literature include topical application of 5-fluorouracil, photodynamic therapy, cryotherapy, and laser therapy (carbon dioxide laser). The choice of the most appropriate regimen should have been an individual decision of the clinician, considering also the location and the extent of the lesion.
authors.affiliation: Medical College, Medical University of Varna, 84 Tzar Osvoboditel str., 9000, Varna, Bulgarien. varna2008@gmail.com.
authors.forename: Ilko
authors.initials: I
authors.lastname: Bakardzhiev
authors.affiliation: "Onkoderma"-Policlinic for Dermatology and Dermatologic Surgery, General Skobelev 26 blvd., Sofia, Bulgaria. assia_chokoeva@abv.bg.
authors.forename: Anastasiya Atanasova
authors.initials: AA
authors.lastname: Chokoeva
authors.affiliation: Policlinic for Dermatology and Venereology, Saint Kliment Ohridski University, Sofia, Bulgarien. georgi_tchernev@yahoo.de.|Medical Faculty, University Hospital Lozenetz, Koziak street 1, 1407, Sofia, Bulgarien. georgi_tchernev@yahoo.de.
authors.forename: Georgi
authors.initials: G
authors.lastname: Tchernev
mesh_terms: D001913:Bowen's Disease / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006801:Humans; D027383:Papillomaviridae / Q000302:isolation & purification
keywords: Bowen; Conservative approach; HPV; Imiquimod; Surgical approach