Bowen's disease

(medicine) Intraepithelial squamous-cell carcinoma of the skin, forming distinctive plaques. A similar carcinoma occurring in mucous membranes.

Key Terms: Cancer, Dermatitis, Melanoma, Paget's disease of the breast, Precancerous dermatosis, Psoriasis.

Definition

Bowen's disease is a superficial precancerous squamous cell cancer, slow-growing (i.e. has not started spreading) skin malignancy. It is named for John Templeton Bowen (1857–1941), an American dermatologist. Bowen's disease is also called precancerous dermatosis.

Description

Red-brown, scaly or crusty patch on the skin that resembles psoriasis, dermatitis or eczema that can occur on any part of the body.

Demographics

Bowen's disease affects both males and females. Women are affected in the genital area three times as often as men. The disease can occur at any age, but is rare in children.

Causes and Symptoms

The exact cause of Bowen's disease is unknown. Like many forms of cancer, long-term sun exposure may be a cause. The skin usually indicates sun damage, such as wrinkling, changes in pigmentation, and loss of elasticity. Ingestion of arsenic has been associated with cases of Bowen's disease found in skin areas unexposed to light or mucous membranes. Human papillomavirus 16 DNA is found repeatedly in Bowen's disease lesions, which suggests that this virus might be a cause. The role of heredity is not well understood. There are cases of Bowen's disease for which a cause cannot be determined.

Symptoms

The symptoms of Bowen's disease include:

• plaque located on or within the skin (intraepidermal)
• open sore that bleeds and crusts and persists for weeks
• wart-like growth that crusts and occasionally bleeds
• persistent, scaly red patch with irregular borders that sometimes crusts or bleeds
• pinkish or brownish raised areas of skin

Diagnosis

Bowen's disease can be confused with such other common skin disorders as psoriasis or types of dermatitis. Paget's disease of the breast and malignant melanoma are other types of cancer which may be confused for Bowen's disease. A medical history, physical examination, and biopsy establish the diagnosis.

Clinical Staging, Treatments, and Prognosis

Treatment usually involves surgical removal of the lesion. Curettage and cautery methods, which include carbon dioxide lasers, liquid nitrogen, and topical fluorouracil (5-fluorouracil, FU) compose the most efficient treatment for management of small solitary lesions.

There can be difficulties with the liquid nitrogen, 5-FU (Efudex, fluoroplex), scraping and burning because Bowen's lesions can hide deep in pores, and cells may extend into the surrounding area where the lesion is visible.

Newer treatments for Bowen's disease include acitretin (Soriatane), an oral medication originally developed to treat psoriasis; and imiquimod (Aldara), an immune response modifier available as a 5% topical cream. Imiquimod has been reported to give good results in treating Bowen's disease of the penis as well as large facial lesions.

Clinical Trials

Dr. Colin Morton and colleagues at the Western Infirmary in the UK have been developing a photodynamic therapy using topical 5-aminolaevulinic acid(5-ALA).

Dr. Lee and colleagues at the University College of Medicine in Korea have been developing a specially designed radioactive skin patch.

Prevention

As with most skin cancers, prolonged exposure to the sun can increase the risk of developing the disease.

Special Concerns

All treatment options for Bowen's disease have a recurrence rate of 5–10%, and no treatment modality seems superior for all clinical situations.

Resources

Books

Beers, Mark H., MD, and Robert Berkow, MD, editors. "Bowen's Disease." Section 10, Chapter 126 In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2002.

Beers, Mark H., MD, and Robert Berkow, MD, editors. "Penile Cancer." Section 17, Chapter 233 In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2002.

Periodicals

Ahmed, I., J., S. Berth-Jones, Charles Holmes, C. J. O. Callaghan, and A. Ilcyhyshyn. "Comparison of Cryotherapy with Curettage in the Treatment of Bowen's Disease: A Prospective Study." British Journal of Dermatology 143 (2000): 759–766.

Chung, Y. L., J. D. Lee, D. Bang, J. B. Lee, K. B. Park, and M. G. Lee. "Treatment of Bowen's disease with a specially designed radioactive skin patch." European Journal Nuclear Medicine 27, no. 7 (July 2000): 842–6.

Cox, N. H."Bowen's Disease: Where Now with Therapeutic Trials?" British Journal of Dermatology 143 (2000):699–700.

Danielsen, A. G., C. Sand, and K. Weismann. "Treatment of Bowen's Disease of the Penis with Imiquimod 5% Cream." Clinical and Experimental Dermatology 28 (November 2003) (Supplement 1): 7–9.

Khandpur, S., and V. K. Sharma. "Successful Treatment of Multiple Premalignant and Malignant Lesions in Arsenical Keratosis with a Combination of Acitretin and Intralesional 5-Fluorouracil." Journal of Dermatology 30 (October 2003): 730–734.

Kossard, S. "Treatment of Large Facial Bowen's Disease: Case Report." Clinical and Experimental Dermatology 28, Supplement 1 (November 2003): 13–15.

Morse, L. G., C. Kendrick, D. Cooper, et al. "Treatment of Squamous Cell Carcinoma with Intralesional 5-Fluorouracil." Dermatologic Surgery 29 (November 2003): 1150–1153.

Morton, Colin, A., Colin Whitehurst, John H. McColl, James V. Moore, and Rona M. MacKie."Photodynamic Therapy for Large or Multiple Patches of Bowen Disease and Basal Cell Carcinoma." Archives Dermatology 137 (March 2001): 319–324.

Nouri, K., C. O'Connell, and M. P. Rivas. "Imiquimod for the Treatment of Bowen's Disease and Invasive Squamous Cell Carcinoma." Journal of Drugs in Dermatology 2 (December 2003): 669–673.

Organizations

American Cancer Society, Inc. 1599 Clifton Road NE, Atlanta, GA 30329, (404)320-3333, . The American Cancer Society (ACS) is a nationwide community-based voluntary health organization dedicated to eliminating cancer as a major health problem and the largest source of private, nonprofit cancer funds. The ACS hopes to prevent cancer, save lives, and diminish suffering from cancer, through research, education, advocacy, and service. 2 July 2001.

National Organizations of Rare Disorders (NORD). PO Box 8923, Fairfield, CT, 06812-8923, (800)999-6673; [cited July 2, 2001]. . NORD is a voluntary health organization dedicated to helping people with rare diseases and assisting the organizations that serve them.

NIH/National Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse. One AMS Circle, Bethesda, MD, 20892-3675.(301)495-4484. . The NIAMS conducts and supports basic, clinical, and epidemiologic research and research training and disseminates information on diseases that include many forms of arthritis and diseases of the musculoskeletal system and the skin. [cited July 2, 2001].

NIH/National Cancer Institute (NCI) Office of Communications-Public Inquiries Office, Building 31, Rm 10A03, 9000 Rockville Pike, Bethesda, MD 20892.(800)422-6237. [cited July 2, 2001]. . Specializes in different aspects of cancer which includes cancer biology, cancer control and population sciences, cancer epidemiology and genetics, cancer prevention, and cancer treatment and diagnosis.

Skin Cancer Foundation. 245 Fifth Avenue, Suite 1403, New York, NY 10016.(212)725-5176. [cited July 2, 2001]. . National and international organization that is concerned exclusively with skin cancer.

Other

Skincancerinfor.com Detailed summary of information about Bowen's disease. [cited 2 July 2001]. .

Questions to Ask the Doctor

• How do I know I have Bowen's disease rather than psoriasis, Paget's disease, dermatitis or another skin cancer?
• Is surgical removal of the affected skin area the best treatment?
• What other treatments for Bowen's disease are available other than surgical removal?

—Laura Ruth, Ph.D.; Rebecca J. Frey, PhD

A dermatosis or form of intraepidermal carcinoma characterized by the development of pinkish or brownish skin papules covered with a thickened horny layer.

In humans, multiple cutaneous squamous cell carcinomas in situ; reported in dogs and cats. There are hyperkeratotic, hyperpigmented plaques.

Bowen's disease
Classification and external resources
Bowen's disease as seen under a microscope
ICD-10	D00.-D09.
ICD-9	230-234
ICD-O:	8081/2
DiseasesDB	1569
eMedicine	derm/59
MeSH	D001913

Bowen's disease (BD) (also known as "squamous cell carcinoma in situ"^[1]:655) is a neoplastic skin disease, considered either as an early stage or intraepidermal form of squamous cell carcinoma. It was named after Dr John T. Bowen, the doctor who first described it in 1912. Erythroplasia of Queyrat is a form of squamous cell carcinoma in situ possibly induced by HPV.^{[citation needed]}

Contents 1 Causes 2 Signs and symptoms 3 Histology 4 Treatment 5 Additional images 6 References 7 External links

Causes

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

Signs and symptoms

Bowen's disease typically presents as a gradually enlarging, well demarcated erythematous plaque with an irregular border and surface crusting or scaling. BD may occur at any age in adults but is rare before the age of 30 years - most patients are aged over 60. Any site may be affected, although involvement of palms or soles is uncommon. BD occurs predominantly in women (70-85% of cases). About 60-85% of patients have lesions on the lower leg, usually in previously or presently sun exposed areas of skin.

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. The cause most frequently found is trivalent arsenic compounds. Freezing, cauterization or diathermy coagulation is often effective treatment.

Histology

Bowen's is equivalent to squamous cell carcinoma in situ. The entire tumor is confined to the epidermis and does not invade into the dermis. 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.

Treatment

Photodynamic therapy (PDT), Cryotherapy (freezing) or local chemotherapy (with 5-fluorouracil) are favored by some clinicians over excision. Because the cells of Bowen's disease have not invaded the dermis, it has a much better prognosis than invasive squamous cell carcinoma. Outstanding result have been noted with the use of imiquimod for Bowen's disease of the skin, including the penis (erythroplasia of Queyrat). Imiquimod is not FDA approved for the treatment of squamous cell carcinoma.

Additional images

References

1. ^ James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. ISBN 0721629210.

External links

• Photo
• Histological slide

v • d • e Tumors: skin cancer (C43-C44/D22-D23, 172-173/216) Epidermis Basal cell carcinoma · Squamous cell carcinoma (Acanthoma) Bowen's disease Dermis Benign fibrous histiocytoma/dermatofibrosarcoma · Dermatofibrosarcoma protuberans Nevi and melanomas Nevus: Melanocytic nevus · Dysplastic nevus · Halo nevus · Spitz nevus Melanoma: Superficial spreading melanoma · Nodular melanoma · lentigo (Lentigo maligna/Lentigo maligna melanoma, Acral lentiginous melanoma) integument, SF, LCT navs: anat/physio, noncongen/congen/neoplasia, symptoms+signs/eponymous, proc

v • d • e Tumors: urogenital neoplasia · genital neoplasia (C51-C63/D25-29, 179-187/218-222) Female Ovaries Glandular and epithelial Clear cell adenocarcinoma · Endometrioid tumor CMS: Krukenberg tumor · Serous cystadenoma/Mucinous cystadenoma · Cystadenocarcinoma/Papillary serous cystadenocarcinoma Sex cord-gonadal stromal Leydig cell tumour · Sertoli cell tumour · Sertoli-Leydig cell tumour · Thecoma · Granulosa cell tumour · Luteoma Connective tissue Fibroma (Meigs syndrome) · Surface epithelial-stromal tumor (Brenner tumour) Germ cell Dysgerminoma · Embryonal carcinoma · Gonadoblastoma · Teratoma · Choriocarcinoma Fallopian tube Adenomatoid tumor Uterus Uterine sarcoma · Leiomyosarcoma Endometrium (Endometrioid tumor), (Uterine papillary serous carcinoma), (Clear cell carcinoma) Adenomyoma Cervix (SCC, Cervical intraepithelial neoplasia) Vagina SCC · Botryoid rhabdomyosarcoma · Adenocarcinoma/Clear cell adenocarcinoma Vulva Papillary hidradenoma · Extramammary Paget's disease Placenta Choriocarcinoma Male Testicles Sex cord-gonadal stromal Sertoli-Leydig cell tumour (Sertoli cell tumor, Leydig cell tumor) Germ cell G Seminoma (Spermatocytic seminoma) · Intratubular germ cell neoplasia NG Embryonal carcinoma · Endodermal sinus tumor · Gonadoblastoma · Teratoma · Choriocarcinoma · Embryoma Prostate Adenocarcinoma · Prostatic intraepithelial neoplasia (HGPIN) · Small cell carcinoma · Transitional cell carcinoma Penis Carcinoma (Extramammary Paget's disease) · Bowen's disease · Bowenoid papulosis · Erythroplasia of Queyrat reproductive system navs: anat female,male/physio/dev, noncongen/congen/neoplasia, symptoms+signs/eponymous, proc

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