From the Research
The best place to biopsy Bowen's disease is at the most clinically suspicious area within the lesion, typically where there is the most thickening, scaling, or crusting, as recommended by the most recent study 1. This approach is crucial in determining the presence of squamous cell carcinoma in situ and potential invasion through the basement membrane, which would indicate progression to invasive squamous cell carcinoma.
Key Considerations
- A punch biopsy or shave biopsy that includes the full thickness of the epidermis and some dermis is recommended, as it provides a comprehensive view of the lesion's histological features 2.
- For larger lesions, multiple biopsies may be necessary to sample different areas, as Bowen's disease can have variable histological features throughout the lesion.
- The periphery of the lesion is often sampled to establish the margins, while the center or most indurated areas are biopsied to assess for potential invasion.
- Local anesthesia should be used, and hemostasis achieved after the procedure, to minimize discomfort and promote healing.
Rationale
The rationale behind this approach is based on the fact that Bowen's disease can progress to invasive squamous cell carcinoma in a significant percentage of cases, making accurate diagnosis through appropriate biopsy technique essential for proper treatment planning 3, 4, 5.
Clinical Implications
The clinical implications of this approach are significant, as it enables healthcare providers to make informed decisions about treatment and management of Bowen's disease, ultimately improving patient outcomes and reducing the risk of morbidity and mortality.
Histopathological Characteristics
The most commonly observed histopathological characteristics of Bowen's disease include squamous-cell hyperplasia, disordered maturation with atypical keratinocytes, atypical mitoses, hyperkeratosis with hypokeratosis, dermal inflammatory cell infiltration, and koilocytosis, as reported in the most recent study 1.