This week’s BMJ has an article about Bowen’s disease and its differential diagnosis. As you might expect, revision from this one was mostly visual, reminding my occipital cortex of what the different images look like; it doesn’t translate well into notes. (Though remember the 5 Ps of lichen planus: pruritic polygonal purple papules and plaques. And remember the thin translucent rolled border around superficial BCCs, which can be used to distinguish them from Bowen’s disease.)
However, there was one very useful bit of advice about using 5-fluorouracil on lesions that are at high risk of ulceration (lower legs in elderly person); start with more infrequent use and increase gradually. So, start with twice-weekly application. After a fortnight, move to alternate nights. Then, daily. Finally, up to bd. If the area becomes bright red and sore, reduce the frequency.
Having never forgotten the time when my well-meaning insistence on treating a frail elderly lady’s lower leg lesion with 5-fluorouracil resulted in her developing a leg ulcer that had still not healed up when she died a few months later from one of her other co-morbidities… well, for one thing, I’m a lot more cautious about that sort of thing than I used to be, and I have definitely learned to abide by the Jurassic Park advice that just because you could do something doesn’t mean you should. But sometimes these lesions do need treating, so I definitely appreciated this snippet.