Bowen's disease

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: Bowen's carcinoma; squamous cell carcinoma in situ of skin; intraepidermal carcinoma skin

Overview

In medicine (dermatology), Bowen's disease (BD) is a sunlight-induced skin disease, considered either as an early stage or intraepidermal form of squamous cell carcinoma.

Historical Perspective

It was named after Dr John T. Bowen, the doctor who first described it in 1912.

Pathophysiology

Microscopic Pathology

The cells in Bowen's are extremely unusual or atypical under the microscope and in many cases look worse under the microscope than the cells of many outright and invading squamous cell carcinomas. The degree of atypia (strangeness, unusualness) seen under the microscope best tells how cells may behave should they invade another portion of the body.

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  Bowen's disease as seen under a microscope

Causes

Common Causes

Causes of BD include solar damage, arsenic, immunosuppression (including AIDS), viral infection (human papillomavirus or HPV) and chronic skin injury and dermatoses.

Causes in Alphabetical Order

• Arsenic
• Chronic skin injury
• Dermatoses
• Immunosuppression
  • Including AIDS
• Solar damage
• Viral infection
  • HPV/human papillomavirus

Epidemiology and Demographics

Age

Bowen's disease may occur at any age in adults but is rare before the age of 30 years - most patients are aged over 60.

Gender

Bowen's disease occurs predominantly in women (70-85% of cases).

Diagnosis

Physical Examination

Bowen's disease typically presents as a gradually enlarging, well demarcated erythematous plaque with an irregular border and surface crusting or scaling.

• 
  Bowen's disease

Skin

Any site may be affected, although involvement of palms or soles is uncommon. A persistent progressive non-elevated red scaly or crusted plaque which is due to an intradermal carcinoma and is potentially malignant. Atypical squamous (resembling fish scales) cells proliferate through the whole thickness of the epidermis. The lesions may occur anywhere on the skin surface or on mucosal surfaces.

Extremities

About three-quarters of patients have lesions on the lower leg (60-85%), usually in previously or presently sun-exposed areas of skin.

Treatment

Surgery and Device Based Therapy

Photodynamic therapy (PDT), Cryotherapy (freezing) or local chemotherapy (with 5-fluorouracil) are favored by some clinicians over excision. Cauterization or diathermy coagulation are often effective treatments as well.