Bowen's Disease

[esawtooth]

My mother has had a small skin lesion on the left knee for a couple of years which was pretty much asymptomatic. Recently, it had started to itch, and I took her to a dermatologist who ordered a biopsy. The biopsy diagnosed the scab like lesion as Bowen's disease. The doc has referred to an oncological general surgeon for excision of the lesion.

Another cause of concern was that before this, for the past few months, she has had a low grade fever and was suffering from constant tiredness. At that time, a scan of her lungs after a bout of laryngitis had revealed some very small cysts, for which the doctor did not want to medicate and recommended to wait.

An year and a half ago, she had undergone total hysterectomy for a uterine fibroid. Before that, her blood test for CA-125 antigen revealed a positive, though the biopsy of the uterus and ovaries was clean.

I am extremely distressed now and need advice about the courses of action we should take. Is it possible that there is another malignity besides the skin disease above? If yes, what kind could it be? Who is the best doctor for me to be discussing these concerns with (I live in India/Delhi)? Above all, is there a good prognosis? Please help.

Thanks in advance!

[esawtooth]

Her fever is low grade. Typically between 98.8F - 99.6F. Her feeling tired is weakly correlated with the fever from what I have observed. I don't know much about the mesh that was inserted; I'll speak to her surgeon for that surgery and get more information about the mesh ASAP. I think it might be prolene, but I will need to confirm. It was a fairly large mesh, and the procedure used was laparoscopic (LPOM). There were complicated adhesions particularly involving the bladder that had lengthened the surgery time, and the location of the hernia in the supra-pubic region did not help matters as I recall.

Her blood work after the mesh surgery was normal. I faintly recall a later blood test that showed some mild possibility of infection but the doc had dismissed that as uninteresting. I'll dig up that report as well. A day after the mesh surgery the surgeon had mentioned that it had been a difficult and rare case for surgery, but there were no complications.

An interesting thing that came to mind about her recovery later was that she felt her body seize a time or two in what felt to her like an attempt by her body to eject the mesh. Those had subsided soon after though and the surgeon had mentioned that there was nothing more to worry about.

Thanks a lot again! Her hernia repair is something I should clearly check in detail. I really appreciate your help in helping her get better :)

[ScalpMassager]

> She had to undergo a somewhat atypical mesh insertion surgery to repair that. It is mostly since that time that she has been complaining of tiredness. Another symptom that we noticed very recently are a few black spots over her stomach that have been growing in number lately.

For tiredness, other than an absence of HRT:  Does she have a low grade fever (is her body temperature somewhat higher than the norm)?  If so, does a blood test show that she's coping with an internal infection?  What type of 'mesh' was used (brand, material)?  (I wonder if there might or might not be a complication from the mesh insertion surgery)

A dermatologist might be of assistance regarding likely cause(s) of the black spots.

[esawtooth]

Thanks a ton for your  inputs! I really appreciate your quick response on this. I hadn't considered the hysterectomy angle. I've just spoken to an endocrinologist about this, and he asked us to get the lesion excised first (quickly) by a general surgeon before we reconsider her other symptoms. He is ambivalent about HRT at this point and sounded concerned about her other symptoms. He has asked us to visit him once the lesion is excised.

To add some more context to her history if that would help, after her hysterectomy, she was feeling very well, though three-four months after that, an incisional hernia had appeared over the bladder. She had to undergo a somewhat atypical mesh insertion surgery to repair that. It is mostly since that time that she has been complaining of tiredness. Another symptom that we noticed very recently are a few black spots over her stomach that have been growing in number lately.

We plan to speak with a general surgeon for the bowen's disease tomorrow. Though after that, we still need to figure out what needs to be done.

[ScalpMassager]

I urge that you accompany your mother to her doctors' visits, so you can take notes and help her ask questions of her doctors, and that activity will help you form an opinion of their competence.  

With a total hysterectomy, has a doctor been asked about hormone replacement therapy?  There are pros and cons, HRT used to be reflexively chosen but it's now recognized to increase the risk of cancer [I wonder if non-equine and/or less synthetic hormones would be helpful].  The specialist to consult would be an endocrinologist.  Your mother's present "quality of life" is a concern that may need to be balanced against the hazards of going on HRT..

Sounds to me like the bowen's disease is being well tended (perhaps less sun exposure would be prudent since there's now been one such outbreak).  While technically anything is "possible", I think discovering an easily treatable and minor skin lesion is not a major concern.