A Deep Learning Approach for Basal Cell Carcinomas and Bowen’s Disease Recognition in Dermatopathology Image

Basal cell carcinomas and Bowen’s disease (squamous cell carcinoma in situ) are the most common cutaneous tumors. The early diagnoses of these diseases are very important due to their better prognosis. But it is a heavy workload for the pathologists to recognize a large number of pathological images and diagnose these diseases. So, there is an urgent need to develop an automatic method for detecting and classifying the skin cancers. This paper presents a recognition system of dermatopathology images based on the deep convolutional neural networks (CNN). The dermatopathology images are collected from the hospital. The deep learning model is trained using different image datasets. It can be found that the recognition accuracy of the system can be improved by using data augmentation even if the number of the clinical samples are not increased. But the recognition accuracy of the system is the highest when the number of the original histological image is increased. The experimental results that the system can correctly recognize 88.5% of patients with basal cell carcinoma and 86.5% of patients with Bowen’s disease.

Pink plaque on the hypogastrium

Bowen’s disease is a type of intraepidermal squamous cell carcinoma usually affecting the elderly and occurring on sun-exposed areas, such as the face, scalp, and limbs. The development of Bowen’s disease in other locations such as the abdomen is rare. In these cases, dermoscopy proves to be a helpful tool in making the diagnosis [1]. A 65-year-old male with no previous medical history presented himself with a nonhealing asymptomatic lesion on the abdomen slowly growing for the last ten years. A dermatological examination revealed a 6-cm well-limited erythematous plaque on the hypogastrium with peripheral pigmentation (Fig. 1). Dermoscopy found central keratin as well as white shiny structures, including white shiny lines, white shiny areas, and rosettes (Fig. 2) as well as brown linear globules and dots on the periphery and looped vessels (Fig. 3). Bowen’s disease was the most likely diagnosis, which was confirmed by histopathology. The patient underwent surgery for excision of the lesion with 5-mm margins.

Efficacy of Photodynamic Therapy for the Treatment of Bowen’s Disease: A Meta-Analysis of Randomized Controlled Trials

<b><i>Background:</i></b> Photodynamic therapy is an established treatment option for Bowen’s disease. Our meta-analysis was aimed at evaluating the efficacy and recurrence of photodynamic therapy or other topical treatments (5-fluorouracil, cryotherapy) and of photodynamic therapy alone or in combination with other therapies (ablative fractional CO₂ laser or plum-blossom needle) for the treatment of Bowen’s disease. <b><i>Methods:</i></b> Trials that met our inclusion criteria were identified from PubMed, EMBASE, Web of Science, and Cochrane Library databases, and meta-analyses were conducted with RevMan V.5.4. The risk of bias was estimated with the Cochrane Collaboration’s risk of bias tools. Complete response rate, recurrence, pain/visual analogue scale score, cosmetic outcome, and adverse events were considered as outcomes. <b><i>Results:</i></b> Of the 2,439 records initially retrieved, 8 randomized controlled trials were included in this meta-analysis. According to our analyses, photodynamic therapy exhibited a significantly higher complete response rate (RR = 1.36, 95% CI [1.01, 1.84], <i>I</i>² = 86%, <i>p</i> = 0.04), less recurrence (RR = 0.53, 95% CI [0.30, 0.95], <i>I</i>² = 0%, <i>p</i> = 0.03), and better cosmetic outcome (RR = 1.34, 95% CI [1.15, 1.56], <i>I</i>² = 0%, <i>p</i> = 0.0002) compared with other treatments. Moreover, there was a significant difference between the complete response rate of photodynamic therapy combined with ablative fractional CO₂ laser and that of photodynamic therapy (RR = 1.85, 95% CI [1.38, 2.49], <i>I</i>² = 0%, <i>p</i> &#x3c; 0.0001). Photodynamic therapy combined with ablative fractional CO₂ laser or plum-blossom needle also showed significantly less recurrence (RR = 0.21, 95% CI [0.09, 0.51], <i>I</i>² = 0%, <i>p</i> = 0.0005) and a lower visual analogue scale score (RR = 0.51, 95% CI [0.06, 0.96], <i>I</i>² = 0%, <i>p</i> = 0.03) than photodynamic therapy alone. However, there was no significant difference in the complete response rate between photodynamic therapy combined with ablative continuous CO₂ laser and photodynamic therapy combined with ablative fractional CO₂ laser (RR = 1.00, 95% CI [0.54, 1.86], <i>I</i>² not applicable, <i>p</i> = 1.00). <b><i>Conclusions:</i></b> This meta-analysis shows that photodynamic therapy can be used in the treatment of Bowen’s disease with better efficacy, less recurrence, and better cosmetic outcomes than cryotherapy and 5-FU. Some methods, including ablative fractional CO₂ laser, can be applied in combination with photodynamic therapy to improve efficacy. However, which laser-assisted photodynamic therapy scheme has the most advantages in the treatment of Bowen’s disease warrants further exploration.

Analysis of molecular mechanisms of development of actinic keratosis: a review

Objective — to study the molecular mechanisms of the development of actinic keratosis (AK) and compare them with Bowen’s disease. Materials and methods. A literature review, analysis of national and international protocols for the diagnosis of AK are presented, which meet the selection criteria. We reviewed works with at least one recommendation for AK diagnostic scenario published after 2015. The systematic literature review is based on modern studies containing descriptions of molecular diagnostics of certain proto-oncogenes to establish the final diagnosis. Interdisciplinary guidelines were also reviewed to further explore all possible diagnostic criteria. Results and discussion. Until now, the molecular mechanisms of AK development have not been fully studied and grouped into a single review. In most of the sources, only p53 protein was mentioned as the main transcription factor regulating apoptosis. However, recent studies prove a sufficient influence of CD95, which, like p53, induces apoptosis and plays a leading role in the development of AK. All precancerous and malignant neoplasms of the skin arise due to mutations in cells, which cause a violation of apoptosis, but there are still no recommendations and a clear diagnostic algorithm that will allow to quickly establish the final diagnosis and make a choice in favor of this or another method of treatment. Conclusions. AK and Bowen’s disease are different stages in the development of the same malignant process, differing in the proliferative activity of cells and the expression of proto-oncogenes CD95, bcl-2, and p16 which can be used as differential diagnostic markers. Thanks to early diagnosis, it is possible to choose the most suitable treatment option, with consideration for modern protocols.