Sau P, McMarlin S L, Sperling L C, Katz R
Department of Dermatology, Walter Reed Army Medical Center, Washington, DC.
Arch Dermatol. 1994 Feb;130(2):204-9.
This article describes the clinical and histologic features of seven cases of Bowen's disease (BD) of the nail bed, evaluates the role of human papillomavirus in the bowenoid change, and discusses optimal therapy.
The patients presented with the clinical features of verruca vulgaris (n = 3), nail dystrophy and onycholysis (n = 2), paronychia (n = 1), and acral melanoma (n = 1). Histologically, the lesions demonstrated acanthosis, hyperkeratosis, and anaplasia, involving the full thickness of the epithelium. In four cases, human papillomavirus type 16 was demonstrated by in situ hybridization. Six lesions were treated by Mohs micrographic surgery, and one case was treated with topical 5% fluorouracil. In two cases, lesions recurred 1 and 2 years following surgery. In the case treated with topical 5% fluorouracil, residual BD was found 6 weeks after therapy. This case was then treated by Mohs surgery.
Bowen's disease of the nail bed and periungual area may present clinically as various inflammatory and neoplastic conditions. An important clinical finding in differentiating BD of the nail bed from verruca is the presence of scaling and onycholysis that are out of proportion to the verrucous changes. Human papillomavirus type 16 may be etiologically related to BD of the nail bed and periungual area. Mohs micrographic surgery is recommended for adequate excision and maximal preservation of normal tissue and function.
本文描述了7例甲床鲍温病（BD）的临床和组织学特征，评估了人乳头瘤病毒在鲍温样改变中的作用，并讨论了最佳治疗方法。
患者表现出寻常疣的临床特征（n = 3）、甲营养不良和甲剥离（n = 2）、甲沟炎（n = 1）以及肢端黑色素瘤（n = 1）。组织学上，病变表现为棘层肥厚、角化过度和间变，累及上皮全层。4例通过原位杂交检测到人乳头瘤病毒16型。6个病变采用莫氏显微外科手术治疗，1例采用5%氟尿嘧啶局部治疗。2例在手术后1年和2年出现病变复发。在采用5%氟尿嘧啶局部治疗的病例中，治疗6周后发现残留的鲍温病。该病例随后采用莫氏手术治疗。
甲床和甲周区域的鲍温病在临床上可能表现为各种炎症性和肿瘤性疾病。将甲床鲍温病与疣区分开来的一个重要临床发现是存在与疣状改变不相称的脱屑和甲剥离。人乳头瘤病毒16型可能与甲床和甲周区域的鲍温病病因相关。推荐采用莫氏显微外科手术进行充分切除，并最大程度地保留正常组织和功能。
