BOWEN'S DISEASE IN THE PERIANAL REGION: A CASE REPORT FROM THE LEGAL AMAZON

Case Presentation Patient E. G. S, female, 70 years old, sought treatment at the coloproctology service of a hospital in Macapá/AP, complaining of itching and discomfort in the perianal and coccygeal regions. During the physical examination, an expansive verrucous lesion with elevated borders was identified, extending from the perianal region to the coccyx (superiorly) and to the gluteal region bilaterally, with an approximate diameter of 5.5 cm. Based on the clinical presentation, the decision was made to perform surgical excision of the lesion and subsequent histopathological analysis. During the surgical excision, partial primary closure was performed due to tension in the area, and healing by secondary intention was chosen. On the first postoperative day (PO), the patient complained of pain in the surgical wound area and the presence of serous secretion. However, on the second PO day, the complaints subsided, and on the third PO day, the patient was discharged without further complaints. According to the histopathological study of the lesion, verrucous carcinoma associated with extensive “in situ” carcinoma (Bowen's Disease) was identified, with compromised lateral margins and pathological staging: pT2. Subsequently, staging was done using chest, abdominal, and cranial computed tomography (CT), all without alterations. During follow-up, the patient progressed without complaints and with total lesion remission and complete healing.

Discussion Bowen's disease is an in situ squamous cell carcinoma, usually asymptomatic, and commonly found in sun-exposed areas (rarely in the perianal region). It is a rare precancerous lesion that can progress to invasive carcinoma in up to 5% of cases. Symptoms include complaints such as burning, itching, and bleeding. Diagnosis is made through histopathological analysis. Treatment involves various approaches, including conventional surgery, topical therapies (such as 5-fluorouracil), and local procedures such as cauterization, with surgical resection with margins considered the most effective.

Conclusion Due to being a mostly asymptomatic and slow-growing disease, a definitive diagnosis may be delayed. Additionally, when symptomatic, the lesion may resemble other conditions, such as genital warts and Paget’s disease. Therefore, a detailed physical examination, combined with a biopsy of the lesion, is essential for the correct and definitive diagnosis of the disease.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025