An Immunohistochemical Study of p53, mdm-2 and bcl-2 Protein Expression in Multiple Bowen's Disease with Invasive Carcinoma

Eun, Chul; Ro, Young Suck; Kim, Young Tae; Lee, Chang Woo; Yu, Hee Joon; Ihm, Chull Wan; Choi, Kyu Chul; Suh, Moon Kyu

Abstract

BACKGROUND: Bowen's disease(BD) is an in situ squamous cell carcinoma(SCC) of the skin, which clinically presents as a scaly slightly elevated erythematous plaque. Approximately two thirds of patients with BD have solitary lesions, whereas the remaining patients have multiple lesions. Lesions of BD have a wide distribution covering both sun-exposed and covered skin. Chronic sunlight exposure is an important etiological factor in many patients, and inorganic arsenicals can cause lesions on unexposed skin. If untreated, 3-5% of BD cases evolve into invasive carcinoma including SCC, basal cell carcinoma(BCC), and sebaceous carcinoma(SC), although the precise mechanism is not yet clear.
OBJECTIVE
The purpose of this study was to investigate the factors which may be involved in the development of BD and progression to invasive carcinoma.
METHODS
We performed immunohistochemical analysis using monoclonal antibodies for p53, mdm-2, and bcl-2 in 7 cases of multiple BD with invasive carcinoma.
RESULTS
In four of 6 cases of SCC immunopositive for p53, at least one lesion of each BD was positive for p53. Among them, two cases showed the consistency of p53 staining between BD and its SCC and the localization of the lesions on sun-exposed areas. On the other hand, two cases of SCC and the associated BD were immunonegative for p53 and positive for mdm-2 and all the lesions developed on the UV-nonexposed areas. In one particular case which had a history of arsenic ingestion, SC was immunopositive for p53, whereas the associated SCC and BD were immunonegative for p53. In one case associated adenoid BCC, BD was immunopositive for p53 and negative for bcl-2, whereas BCC was immunonegative for p53 and strongly positive for bcl-2.
CONCLUSION
These results suggest that UV light may play a role in the development of BD and its progression to SCC and in addition to p53, some additional factor or conditions are required in the progression towards these invasive carcinomas from BD.