Bowen Disease Clinical Presentation

  • Author: Mark P Eid, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 24, 2012
 

History

Patients often present with an asymptomatic, slowly enlarging, erythematous, well-demarcated scaly patch or plaque. It may occur anywhere on the mucocutaneous surface. A delay in diagnosis of Bowen disease often is encountered because the lesion is asymptomatic; early skin changes may be subtle and overlap with clinical features seen in many conditions, such as tinea corporis, nummular eczema, seborrheic keratosis,[13, 14] Paget disease, superficial basal cell carcinoma, actinic keratosis, and psoriasis. A classic clinical history is presentation of a non–steroid-responsive dermatosis.

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Physical

Bowen disease presents as a single lesion in two thirds of cases. Lesions may appear on sun-exposed or covered skin. The head, neck, and extremities are the most commonly affected anatomic locations in men, while the lower limbs and cheeks are most commonly affected in women. Lesions, as shown in the images below, vary in size from a few millimeters to several centimeters in diameter.

Squamous cell carcinoma in situ, Bowen disease. CoSquamous cell carcinoma in situ, Bowen disease. Courtesy of Hon Pak, MD. Bowen disease right temple. Bowen disease right temple.

A sharply demarcated, irregular border usually is present. Lesions are erythematous, scaly patches or plaques that may become hyperkeratotic, crusted, fissured, or ulcerated. Rarely, the lesions are pigmented, especially in the genital region and the nails. Lesions in these locations may simulate melanoma.[15] Bowen disease also may occur on mucous membranes. When it arises on the glans penis, it is referred to as erythroplasia of Queyrat and presents as an erythematous, moist, velvety or smooth plaque, as demonstrated in the image below.

Erythroplasia of Queyrat, squamous cell carcinoma Erythroplasia of Queyrat, squamous cell carcinoma in situ of the glans penis.
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Causes

Bowen disease may arise de novo or from a preexisting actinic keratosis. The etiology is most likely multifactorial.

  • Chronic UV radiation: The age and sun-exposed body distribution of Bowen disease suggests the importance of chronic sun damage as a factor in the carcinogenesis of Bowen disease.[11]
  • Arsenic exposure: The literature supports an association between Bowen disease and arsenic exposure, often occurring after a time lag of 10 years. The main sources of arsenic exposure include Fowler solution, a medication formerly used to treat psoriasis; Gay solution, a medication formerly used to treat asthma; contaminated well water; and certain pesticides.[9]
  • Human papillomavirus: Human papillomavirus type 16 is by far the most common subtype isolated from lesions of Bowen disease, although other subtypes, such as HPV 2, 18, 31, 33, 54, 56, 61, 62, and 73 also have been found.[16, 17, 18]
  • Immunosuppression: Immunosuppressed patients with Bowen disease are more likely to have multiple tumors and more aggressive tumors.[19]
  • Other possible causes include genetic factors, trauma, other chemical carcinogens, and x-ray radiation.
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Contributor Information and Disclosures
Author

Mark P Eid, MD  Resident Physician, Department of Dermatology, Milton S Hershey Medical Center, Pennsylvania State University College of Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Bryan E Anderson, MD  Associate Professor, Department of Dermatology, Pennsylvania State University College of Medicine

Bryan E Anderson, MD is a member of the following medical societies: American Academy of Dermatology, American Contact Dermatitis Society, and Pennsylvania Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Kelly M Cordoro, MD  Assistant Professor of Clinical Dermatology and Pediatrics, Department of Dermatology, University of California, San Francisco School of Medicine

Kelly M Cordoro, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Association of Professors of Dermatology, Dermatology Foundation, Medical Society of Virginia, National Psoriasis Foundation, Society for Pediatric Dermatology, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Edward F Chan, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Mark L. Welch, MD, Theresa Dressler Conologue, DO, FAAD, and Carrie A.H. Hall, MD, to the development and writing of this article.

References

  1. Chute CG, Chuang TY, Bergstralh EJ, Su WP. The subsequent risk of internal cancer with Bowen's disease. A population-based study. JAMA. Aug 14 1991;266(6):816-9. [Medline].

  2. Reizner GT, Chuang TY, Elpern DJ, Stone JL, Farmer ER. Bowen's disease (squamous cell carcinoma in situ) in Kauai, Hawaii. A population-based incidence report. J Am Acad Dermatol. Oct 1994;31(4):596-600. [Medline].

  3. Cox NH, Eedy DJ, Morton CA. Guidelines for management of Bowen's disease: 2006 update. Br J Dermatol. Jan 2007;156(1):11-21. [Medline].

  4. Arbesman H, Ransohoff DF. Is Bowen's disease a predictor for the development of internal malignancy? A methodological critique of the literature. JAMA. Jan 23-30 1987;257(4):516-8. [Medline].

  5. Graham JH, Helwig EB. Bowen's disease and its relationship to systemic cancer. AMA Arch Derm. Aug 1959;80(2):133-59. [Medline].

  6. Jaeger AB, Gramkow A, Hjalgrim H, Melbye M, Frisch M. Bowen disease and risk of subsequent malignant neoplasms: a population-based cohort study of 1147 patients. Arch Dermatol. Jul 1999;135(7):790-3. [Medline].

  7. Poole S, Fenske NA. Cutaneous markers of internal malignancy. II. Paraneoplastic dermatoses and environmental carcinogens. J Am Acad Dermatol. Feb 1993;28(2 Pt 1):147-64. [Medline].

  8. Jaeger AB, Gramkow A, Hjalgrim H, Melbye M, Frisch M. Bowen disease and risk of subsequent malignant neoplasms: a population-based cohort study of 1147 patients. Arch Dermatol. Jul 1999;135(7):790-3. [Medline].

  9. Shannon RL, Strayer DS. Arsenic-induced skin toxicity. Hum Toxicol. Mar 1989;8(2):99-104. [Medline].

  10. Gupta S, Nutan, Dogra S, Kanwar AJ. Bowen Disease over photoprotected site in an Indian male. Dermatol Online J. Oct 15 2009;15(10):16. [Medline].

  11. Kossard S, Rosen R. Cutaneous Bowen's disease. An analysis of 1001 cases according to age, sex, and site. J Am Acad Dermatol. Sep 1992;27(3):406-10. [Medline].

  12. Kovács A, Yonemoto K, Katsuoka K, Nishiyama S, Harhai I. Bowen's disease: statistical study of a 10 year period. J Dermatol. Apr 1996;23(4):267-74. [Medline].

  13. Böer-Auer A, Jones M, Lyasnichaya OV. Cytokeratin 10-negative nested pattern enables sure distinction of clonal seborrheic keratosis from pagetoid Bowen's disease. J Cutan Pathol. Jan 11 2012;[Medline].

  14. Terada T. Pigmented Bowen disease arising in pigmented reticulated seborrheic keratosis. Int J Clin Oncol. Dec 2010;15(6):608-10. [Medline].

  15. Saxena A, Kasper DA, Campanelli CD, Lee JB, Humphreys TR, Webster GF. Pigmented Bowen's disease clinically mimicking melanoma of the nail. Dermatol Surg. Dec 2006;32(12):1522-5. [Medline].

  16. Derancourt C, Mougin C, Chopard Lallier M, Coumes-Marquet S, Drobacheff C, Laurent R. [Oncogenic human papillomaviruses in extra-genital Bowen disease revealed by in situ hybridization]. Ann Dermatol Venereol. Jun-Jul 2001;128(6-7):715-8. [Medline].

  17. McKee P, Calonje E, Granter S. Tumors of the surface epithelium. In: Pathology of the Skin. 2. 3rd. London: Elsevier Mosby; 2005:1193-1197.

  18. Shim WH, Park HJ, Kim HS, Kim SH, Jung DS, Ko HC, et al. Bowenoid Papulosis of the Vulva and Subsequent Periungual Bowen's Disease Induced by the Same Mucosal HPVs. Ann Dermatol. Nov 2011;23(4):493-6. [Medline]. [Full Text].

  19. Drake AL, Walling HW. Variations in presentation of squamous cell carcinoma in situ (Bowen's disease) in immunocompromised patients. J Am Acad Dermatol. Jul 2008;59(1):68-71. [Medline].

  20. Bargman H, Hochman J. Topical treatment of Bowen's disease with 5-Fluorouracil. J Cutan Med Surg. Mar-Apr 2003;7(2):101-5. [Medline].

  21. Fulton JE Jr, Carter DM, Hurley HJ. Treatment of Bowen's disease with topical 5-fluorouracil under occlusion. Arch Dermatol. Feb 1968;97(2):178-80. [Medline].

  22. Sturm HM. Bowen's disease and 5-fluorouracil. J Am Acad Dermatol. Dec 1979;1(6):513-22. [Medline].

  23. Welch ML, Grabski WJ, McCollough ML, et al. 5-fluorouracil iontophoretic therapy for Bowen's disease. J Am Acad Dermatol. Jun 1997;36(6 Pt 1):956-8. [Medline].

  24. Mackenzie-Wood A, Kossard S, de Launey J, Wilkinson B, Owens ML. Imiquimod 5% cream in the treatment of Bowen's disease. J Am Acad Dermatol. Mar 2001;44(3):462-70. [Medline].

  25. van Egmond S, Hoedemaker C, Sinclair R. Successful treatment of perianal Bowen's disease with imiquimod. Int J Dermatol. Mar 2007;46(3):318-9. [Medline].

  26. Alessi SS, Sanches JA, de Oliveira WR, Messina MC, Pimentel ER, Festa Neto C. Treatment of cutaneous tumors with topical 5% imiquimod cream. Clinics (Sao Paulo). 2009;64(10):961-6. [Medline].

  27. Imiquimod for superficial and in situ skin malignancy. Drug Ther Bull. Oct 2009;47(10):113-6. [Medline].

  28. Fernandez-Vozmediano J, Armario-Hita J. Infiltrative squamous cell carcinoma on the scalp after treatment with 5% imiquimod cream. J Am Acad Dermatol. Apr 2005;52(4):716-7. [Medline].

  29. Dupree MT, Kiteley RA, Weismantle K, Panos R, Johnstone PA. Radiation therapy for Bowen's disease: lessons for lesions of the lower extremity. J Am Acad Dermatol. Sep 2001;45(3):401-4. [Medline].

  30. Zygogianni A, Kouvaris J, Tolia M, Kyrgias G, Beli I, Kantzou I, et al. The Potential Role of Radiation Therapy in Bowen's Disease: a Review of the Current Literature. Rev Recent Clin Trials. Aug 25 2011;[Medline].

  31. [Guideline] Braathen LR, Szeimies RM, Basset-Seguin N, et al. Guidelines on the use of photodynamic therapy for nonmelanoma skin cancer: an international consensus. International Society for Photodynamic Therapy in Dermatology, 2005. J Am Acad Dermatol. Jan 2007;56(1):125-43. [Medline].

  32. Jones CM, Mang T, Cooper M, Wilson BD, Stoll HL Jr. Photodynamic therapy in the treatment of Bowen's disease. J Am Acad Dermatol. Dec 1992;27(6 Pt 1):979-82. [Medline].

  33. [Guideline] Christensen E, Warloe T, Kroon S, et al. Guidelines for practical use of MAL-PDT in non-melanoma skin cancer. J Eur Acad Dermatol Venereol. Oct 6 2009;[Medline].

  34. Cleary RK, Schaldenbrand JD, Fowler JJ, Schuler JM, Lampman RM. Treatment options for perianal Bowen's disease: survery of American Society of Colon and Rectal Surgeons Members. Am Surg. Jul 2000;66(7):686-8. [Medline].

  35. Leibovitch I, Huilgol SC, Selva D, Richards S, Paver R. Cutaneous squamous carcinoma in situ (Bowen's disease): treatment with Mohs micrographic surgery. J Am Acad Dermatol. Jun 2005;52(6):997-1002. [Medline].

  36. Tantikun N. Treatment of Bowen's disease of the digit with carbon dioxide laser. J Am Acad Dermatol. Dec 2000;43(6):1080-3. [Medline].

  37. Neubert T, Lehmann P. Bowen's disease - a review of newer treatment options. Ther Clin Risk Manag. Oct 2008;4(5):1085-95. [Medline].

  38. Moreno G, Chia AL, Lim A, Shumack S. Therapeutic options for Bowen's disease. Australas J Dermatol. Feb 2007;48(1):1-8; quiz 9-10. [Medline].

  39. Arnold HL, Odom RB, James WD. Bowen's disease. In: Arnold HL, Andrews GC, Odom RB, James WB, eds. Andrews' Diseases of the Skin. 8th ed. Philadelphia, Pa: WB Saunders; 1990:783-5.

  40. Gard D. Nonpigmented premalignant lesions of the skin. Clin Plast Surg. Apr 1987;14(2):413-23. [Medline].

  41. Lee MM, Wick MM. Bowen's disease. Clin Dermatol. Jan-Mar 1993;11(1):43-6. [Medline].

  42. Ragi G, Turner MS, Klein LE, Stoll HL Jr. Pigmented Bowen's disease and review of 420 Bowen's disease lesions. J Dermatol Surg Oncol. Jul 1988;14(7):765-9. [Medline].

 
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Squamous cell carcinoma in situ, Bowen disease. Courtesy of Hon Pak, MD.
Bowen disease right temple.
Erythroplasia of Queyrat, squamous cell carcinoma in situ of the glans penis.
 
 
 
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