Dermatology Oasis

Editor: Dr. Nameer Al-Sudany (IRAQ)

Bowenoid Papulosis

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* A rare form of intraepithelial neoplasia (a pre-cancerous dermatosis).
* In females it is vulvar intraepithelial neoplasis (VIN) and in males it is a type of penile intraepithelial neoplasia.
* HPV has been closely linked to BP as a cause.
* Most cases of BP are benign, however, a small percentage may transform into invasive squamous cell carcinoma (penile or vulvar cancer).
* Sexually active people may be at risk of getting BP, it is most often passed through direct skin-to-skin sexual contact. So partners of patients with BP should be screened for other forms of intraepithelial neoplasia (cervical, penile, vulvar and anal).
* Men and women are equally at risk and the peak incidence is in sexually active persons under 30 years of age.
* It usually presents as small red, brown or flesh-colored flat or warty papules appear most commonly on the shaft of the penis or labia of females. The lesions may also involve other parts of the genitals as well as in and around the anus. The condition is usually asymptomatic but occasionally lesions may become inflamed, itchy and painful.
* BP tends to spontaneously disappear within several months and if a woman is pregnant when it is diagnosed it will often disappear after delivery. If it is persistent this is an indication for active treatment because of the chance of developing skin cancer.
* Once infected with HPV you may become a lifelong carrier of the virus and recurrence of BP or other intraepithelial cancers in the genital area is possible.
* Diagnosis of BP is made by its typical clinical appearance, especially with the aid of dermoscopy, or by skin biopsy. SCC in situ pathology is diagnostic on skin biopsy.
* Treatment: because it usually runs a benign course with many cases spontaneously regressing, treatment is often unnecessary. Lesions should be re-examined every 3 to 6 months so that any changes may be picked up early.
If the lesions are persistent, treatment of BP is the same as for genital warts i.e. usually destruction of the lesions via several medical and/or surgical procedures. Regular checks are necessary after treatment to ensure the condition has completely resolved.
Summary: BP is wart clinically and carcinoma in situ histopathologically!

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