PMC6311265_01
A 33 mm Bowen's disease lesion of the sternum (Patient 4). Cross-polarized photography is applied to enhance the visualization of the vascular pattern. Panel (a): the lesion at baseline. Panel (b): the area of the lesion at day 7 of treatment (one week after treatment onset with cryosurgery at day 0 and 4 daily applications of ingenol mebutate in days 0-3 of treatment). The white label is included for calibration purposes. Panel (c): the site of the lesion at 12 months follow-up. A slightly hypopigmented shallow scar is evident with excellent skin healing (hair follicle preservation) in a skin location of overall problematic healing features (sternum).
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A total of 4 patients (3 females and 1 male; average age: 76.5 years) with 4 BD lesions (20-70mm maximal diameter; average: 36.2mm) were treated with cryosurgery followed by ingenol mebutate according to the above combination scheme (Table 1 and Figure 1). However, the local tissue reaction was reported to peak at day 7 of treatment (Figure 1(b)) and subsequently started to subside. Taking treatment outcomes together, clearance (complete response) was achieved in all 4 BD cases and no relapses were observed at 12 months' follow-up (Figure 1(c)).
Dermoscopic images of the lesion acquired with the digital dermatoscope incorporated to the NITID device and the corresponding OCT image of Bowen's lesion shown in Figure 1. The white line on the dermatoscopic image corresponds to the section scanned by OCT. Panels (a, b): the lesion at baseline. The left half of the OCT scan includes a healthy skin segment (control) featuring a well-defined epidermis (asterisk). At the transition of healthy skin to the lesion, the typical for Bowen's disease thickening and disarrangement of the epidermis becomes evident (right to the arrow). Panels (b, d): the site of the lesions at the 12th month follow-up. There is normalization of the epidermis in the dermoscopic and the OCT images (asterisk). The focal hyperkeratosis evident in the dermatoscopic image (Panel (b), arrow) is also evident in the OCT image as a disruption in the epidermis (Panel (d), arrow) which, however, causes no concern as the epidermis is homogenous throughout the scanned section.
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In accordance with findings by other authors, however with different OCT devices, OCT imaging of the BD lesions at baseline revealed a thickened epidermis without a prominent granular layer in all cases (Figure 2(c)). At 12 months' follow-up, the posttreatment hyperreflectiveness of the dermis had subsided, leaving behind a pattern almost indistinguishable from normal skin (Figure 2(d)).