Bowen's disease
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sara Mohsin, M.D.[2] Jesus Rosario Hernandez, M.D. [3]
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
Pathophysiology
Microscopic Pathology
- Cells in Bowen's disease are extremely unusual or atypical under the microscope
- In many cases, cells look worse under the microscope than the cells of many outright and invading squamous cell carcinomas
- Degree of atypia (strangeness, unusualness) seen under the microscope best tells how cells may behave (should they invade another portion of the body)[1][2]
- Borst-Jadassohn phenomenon[3][4]
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Causes
Common causes of Bowen's disease include:
- Solar damage due to long-term sun exposure or use of sunbeds, especially in people with fair skin
- Arsenic
- Patients with weak immune system due to:
- Viral infection
- Previous radiotherapy treatment
- Chronic skin injury
- Dermatoses
Epidemiology and Demographics
Age
- Bowen's disease can affect adults of any age, most commonly involves older patients in their 60s or 70s
- It is rare before the age of 30 years
Gender
- Bowen's disease occurs predominantly in women (70-85% of cases)
Natural History, Complications and Prognosis
- Bowen's disease grows very slowly over the period of months or even years[5]
- It is easily treatable if diagnosed in time
- If left undiagnosed, untreated or neglected, Bowen's disease can ultimately progressively develop into invasive squamous cell carcinoma of the skin in 1 in 20-30 people (i.e. 3-5% risk)
- SCC is a treatable condition, but if it's deeper or invasive, it means it's very serious
Diagnosis
Symptoms
- It usually appears as one or more skin patches with following characteristics:[5]
- Following changes in the skin patch are the signs that bowen's disease has turned into invasive squamous cell carcinoma of the skin:
- Common sites involved are:[6][7][8]
Skin
- Lesions can occur anywhere on the skin surface or on mucosal surfaces, although the 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
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Extremities
- About three-quarters of the patients have lesions on the lower leg (60-85%), usually in previously or presently sun-exposed areas of skin
Head and neck area
- Being prone to the sun exposure, head and neck area is also one of the common sites to be affected by Bowen's disease
Skinfolds
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Genitourinary system=
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Physical Examination
- Bowen's disease typically presents as a gradually enlarging, well demarcated erythematous plaque with an irregular border and surface crusting or scaling.[9][10][11]
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Dermoscopy
- Dermoscopy
Skin biopsy
- Skin biopsy must be done when Bowen's disease can't be surely differentiated from other skin lesions on physical examination
Treatment
Surgery and Device Based Therapy
- Excision
- 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.[12]
- Photodynamic therapy (PDT)[13][14][15][16][17][18]
- Radiation therapy[19][20][21][22][23][24]
Differentiating Bowen's disease from other Diseases
- Bowen's disease must be differentiated from the following:
References
- ↑ Nemkaeva RM, Kurmashov NA, Oslopova S (1988). "[Bowen's disease]". Vestn Dermatol Venerol (8): 71–2. PMID 3195216.
- ↑ Scarborough DA, Bisaccia EP, Yoder FW (1982). "Solitary pigmented Bowen's disease". Arch Dermatol. 118 (11): 954–5. PMID 7138058.
- ↑ Yanagihara S, Oiso N, Hirota N, Kato M, Miyake S, Kawada A (2019). "Acantholytic Bowen's disease histopathologically showing the Borst-Jadassohn phenomenon". Eur J Dermatol. doi:10.1684/ejd.2019.3545. PMID 31145080.
- ↑ Baykal C, Buyukbabani N, Babuna G, Polat Ekinci A, Kurul S (2016). "Giant Bowen's disease histologically showing Borst-Jadassohn phenomenon and complicated with squamous cell carcinoma development". J Eur Acad Dermatol Venereol. 30 (10): e88–e89. doi:10.1111/jdv.13335. PMID 26373350.
- ↑ 5.0 5.1 "Bowen's disease - NHS".
- ↑ Wagner RF, Grande DJ (1986). "Solitary pigmented Bowen's disease of the scrotum". J Dermatol Surg Oncol. 12 (10): 1114–5. PMID 3760318.
- ↑ Al-Dawsari NA, Raslan W, Dawamneh MF (2014). "Pigmented Bowen's disease of the penis and scrotum in a patient with AIDS". Dermatol Online J. 20 (4): 22337. PMID 24746300.
- ↑ Narahira A, Yanagi T, Kitamura S, Hata H, Shimizu H (2019). "Dermoscopic features of genital pigmented Bowen's disease: Report of a case and review of the published work". J Dermatol. doi:10.1111/1346-8138.14938. PMID 31141219.
- ↑ Inoue T, Kobayashi K, Sawada M, Ishizaki S, Ito H, Fujibayashi M; et al. (2010). "Dermoscopic Features of Pigmented Bowen's Disease in a Japanese Female Mimicking Malignant Melanoma". Dermatol Res Pract. 2010. doi:10.1155/2010/543091. PMC 2929512. PMID 20811602.
- ↑ Hayashi Y, Tanaka M, Suzaki R, Mori N, Konohana I (2009). "Dermoscopy of Pigmented Bowen's Disease Mimicking Early Superficial Spreading Melanoma". Case Rep Dermatol. 1 (1): 11–15. doi:10.1159/000227284. PMC 2895203. PMID 20652107.
- ↑ Yang Y, Lin J, Fang S, Han S, Song Z (2017). "What's new in dermoscopy of Bowen's disease: two new dermoscopic signs and its differential diagnosis". Int J Dermatol. 56 (10): 1022–1025. doi:10.1111/ijd.13734. PMID 28832993.
- ↑ Neubert T, Lehmann P (2008). "Bowen's disease - a review of newer treatment options". Ther Clin Risk Manag. 4 (5): 1085–95. PMC 2621408. PMID 19209288.
- ↑ Wong TW, Sheu HM, Lee JY, Fletcher RJ (2001). "Photodynamic therapy for Bowen's disease (squamous cell carcinoma in situ) of the digit". Dermatol Surg. 27 (5): 452–6. PMID 11359493.
- ↑ Britton JE, Goulden V, Stables G, Stringer M, Sheehan-Dare R (2005). "Investigation of the use of the pulsed dye laser in the treatment of Bowen's disease using 5-aminolaevulinic acid phototherapy". Br J Dermatol. 153 (4): 780–4. doi:10.1111/j.1365-2133.2005.06830.x. PMID 16181460.
- ↑ Kang HK, Yun JH, Son YM, Roh JY, Lee JR (2014). "Photodynamic Therapy for Bowen's Disease of the Vulva Area". Ann Dermatol. 26 (2): 241–5. doi:10.5021/ad.2014.26.2.241. PMC 4037679. PMID 24882981.
- ↑ Dijkstra AT, Majoie IM, van Dongen JW, van Weelden H, van Vloten WA (2001). "Photodynamic therapy with violet light and topical 6-aminolaevulinic acid in the treatment of actinic keratosis, Bowen's disease and basal cell carcinoma". J Eur Acad Dermatol Venereol. 15 (6): 550–4. PMID 11843215.
- ↑ Harth Y, Hirshowitz B, Kaplan B (1998). "Modified topical photodynamic therapy of superficial skin tumors, utilizing aminolevulinic acid, penetration enhancers, red light, and hyperthermia". Dermatol Surg. 24 (7): 723–6. PMID 9693665.
- ↑ de Haas ER, de Vijlder HC, Sterenborg HJ, Neumann HA, Robinson DJ (2008). "Fractionated aminolevulinic acid-photodynamic therapy provides additional evidence for the use of PDT for non-melanoma skin cancer". J Eur Acad Dermatol Venereol. 22 (4): 426–30. doi:10.1111/j.1468-3083.2007.02445.x. PMID 18031503.
- ↑ Anna Z, John K, Maria T, George K, Ivelina B, Ioanna K; et al. (2012). "The potential role of radiation therapy in Bowen's disease: a review of the current literature". Rev Recent Clin Trials. 7 (1): 42–6. PMID 21864250.
- ↑ Lukas VanderSpek LA, Pond GR, Wells W, Tsang RW (2005). "Radiation therapy for Bowen's disease of the skin". Int J Radiat Oncol Biol Phys. 63 (2): 505–10. doi:10.1016/j.ijrobp.2005.02.024. PMID 16168842.
- ↑ Herman JM, Pierce LJ, Sandler HM, Griffith KA, Jabbari S, Hiniker SM; et al. (2008). "Radiotherapy using a water bath in the treatment of Bowen's disease of the digit". Radiother Oncol. 88 (3): 398–402. doi:10.1016/j.radonc.2008.05.025. PMID 18571754.
- ↑ Goodman CR, DeNittis A (2017). "Photon irradiation using a water bath technique for treatment of confluent carcinoma in situ of the hand, digits, and nail bed: a case report". J Med Case Rep. 11 (1): 86. doi:10.1186/s13256-017-1233-3. PMC 5372342. PMID 28356127.
- ↑ Hunt WT, Cameron A, Craig P, de Berker DA (2013). "Multiple-digit periungual Bowen's disease: a novel treatment approach with radiotherapy". Clin Exp Dermatol. 38 (8): 857–61. doi:10.1111/ced.12149. PMID 23937119.
- ↑ Dupree MT, Kiteley RA, Weismantle K, Panos R, Johnstone PA (2001). "Radiation therapy for Bowen's disease: lessons for lesions of the lower extremity". J Am Acad Dermatol. 45 (3): 401–4. doi:10.1067/mjd.2001.116581. PMID 11511838.