Author: Vanessa Ngan, Staff Writer, 2003.
Bowenoid papulosis is a rare form of intraepithelial neoplasia. This means it is a pre-cancerous skin condition. It presents as single or multiple small, red, brown or flesh-coloured spots or patches on the genitals of males and females. In females it is one type of vulvar intraepithelial neoplasia (VIN) and in males it is a type of penile intraepithelial neoplasia.
Human papillomavirus (HPV), the cause of genital warts and some genital cancers, has been closely linked to bowenoid papulosis. Although most cases of bowenoid papulosis are benign (harmless) a small percentage may transform into invasive squamous cell carcinoma (penile or vulvar cancer).
Sexually active people may be at risk of getting bowenoid papulosis. As in genital warts, HPV transmission is most often passed through direct skin-to-skin sexual contact. Partners of patients with bowenoid papulosis 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.
Small red, brown or flesh-coloured flat or warty lesions appear most commonly on the shaft of the penis or labia of females. They may also be present on other parts of the genitals as well as in and around the anus. The condition is usually symptomless but occasionally lesions may become inflamed, itchy and painful. The diagnosis is usually made by skin biopsy.
Bowenoid papulosis tends to spontaneously disappear within several months and if a young 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 bowenoid papulosis or other intraepithelial cancers in the genital area is possible.
Bowenoid papulosis may be diagnosed by its typical clinical appearance, especially with the aid of dermoscopy, or by skin biopsy. Squamous cell carcinoma in situ pathology is diagnostic on skin biopsy.
Because bowenoid papulosis 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 bowenoid papulosis is the same as for genital warts. This is usually destruction of the lesions via several medical and/or surgical procedures (see Genital warts: treatment). Regular checks are necessary after treatment to ensure the condition has completely resolved.
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