Bowens Disease

Bowen's disease is a rare, potentially malignant intraepithelial squamous cell carcinoma (carcinoma in situ). If the lesion is visible, biopsy and histopathologic evaluation is required to distinguish it from other perianal dermatoses. Once the diagnosis is made, we perform "anal mapping," to assess the extent of the disease and to ensure excision of the lesion with negative microscopic margins. The "anal mapping" technique consists of biopsies taken at 1 cm from the edge of the lesion and in all four quadrants of the perineum. Biopsies are taken at the dentate line, anal verge, and the perineum. In the absence of invasive cancer, a wide local excision is performed. Small defects are primarily closed, while large wounds are covered by split thickness or rotational or advancement flaps or left to heal by secondary intention. In the presence of invasive carcinoma, a more aggressive approach such as abdominoperineal resection or combined chemoradiation therapy is indicated. Microscopic disease serendipitously found in hem-orrhoidectomy specimens is conservatively treated with close follow up. Current controversy surrounds the treatment of Bowen's disease. Recent data suggest that areas of anal intraepithelial neoplasia can usually be evaluated. If this conservative approach is ultimately proven sufficient, then the disfiguring excisional procedure will be avoided.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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