eMedicine Specialties > Dermatology > Malignant Neoplasms

Bowen Disease: Differential Diagnoses & Workup

Author: Mark P Eid, MD, Resident Physician, Department of Dermatology, Milton S Hershey Medical Center, Pennsylvania State University College of Medicine
Coauthor(s): Bryan E Anderson, MD, Associate Professor, Department of Dermatology, Pennsylvania State University College of Medicine
Contributor Information and Disclosures

Updated: Dec 16, 2009

Differential Diagnoses

Actinic Keratosis
Squamous Cell Carcinoma
Basal Cell Carcinoma
Tinea Corporis
Lichen Simplex Chronicus
Paget Disease, Mammary
Psoriasis, Plaque

Other Problems to Be Considered

Benign lichenoid keratosis
Eczema
Paget disease (extramammary)

Workup

Procedures

  • Skin biopsy: Perform a shave or punch biopsy to confirm the diagnosis of Bowen disease. Incorporating follicular structures in the biopsy material is helpful, as is sampling many areas of larger lesions to exclude evidence of invasion. These procedures are typically performed in an office setting with the patient under local anesthesia. Pathologic analyses are best completed by dermatopathologists.
  • Complete skin examination: Perform a total body skin examination on patients with Bowen disease on sun-exposed skin. Studies indicate a higher incidence of nonmelanoma skin cancers may exist in these patients.

Histologic Findings

Bowen disease is a full-thickness anaplasia of the epidermis, with loss of the normal maturation of its components. Keratinocytes are atypical and disorderly, often described as having a windblown appearance. Although the basal cell layer is intact, extension of keratinocyte atypia down the follicular epithelium is seen. Vacuolization, mitoses, individually keratinizing cells, and multinucleated cells are present in the epidermis. Large pale keratinocytes with abundant ground-glass cytoplasm, so-called pagetoid cells, often are distributed haphazardly throughout the epidermis. Hyperkeratosis, parakeratosis, and acanthosis are seen to some degree in lesions of Bowen disease. The upper dermis has a moderate lymphocytic infiltrate.

More on Bowen Disease

Overview: Bowen Disease
Differential Diagnoses & Workup: Bowen Disease
Treatment & Medication: Bowen Disease
Follow-up: Bowen Disease
Multimedia: Bowen Disease
References
[ CLOSE WINDOW ]

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. 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].

  14. 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].

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

  16. 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].

  17. 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].

  18. 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].

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

  20. 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].

  21. 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].

  22. 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].

  23. 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].

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

  25. 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].

  26. 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].

  27. [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].

  28. 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].

  29. [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].

  30. 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].

  31. 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].

  32. 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].

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

  34. 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].

  35. 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.

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

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

  38. 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].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

Bowen disease, Bowen’s disease, squamous cell carcinoma in situ, SCC, human papilloma virus 16, HPV 16, human papillomavirus 16

[ CLOSE WINDOW ]

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.

Medical Editor

Kelly M Cordoro, MD, Assistant Professor, Pediatric and Adult Dermatology, Department of Dermatology, University of California at San Francisco
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.

Pharmacy Editor

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.

Managing Editor

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.

CME Editor

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, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.