eMedicine Specialties > Dermatology > Malignant Neoplasms

Bowen Disease

Author: Mark L Welch, MD, Clinical Assistant Professor, Department of Dermatology, Howard University; Assistant Professor, Department of Dermatology, Uniformed Services University of Health Sciences
Coauthor(s): Theresa Conologue, DO, Physician, Department of Dermatology, National Capital Consortium, Walter Reed Army Medical Center; Carrie A H Hall, MD, Resident Physician, National Capital Consortium Dermatology Residency Program, National Naval Medical Center
Contributor Information and Disclosures

Updated: Jul 15, 2008

Introduction

Background

First described by John T. Bowen in 1912, Bowen disease is a squamous cell carcinoma (SCC) in situ with the potential for significant lateral spread (see Squamous Cell Carcinoma). Larger lesions can reach several centimeters in diameter. Much controversy exists as to whether Bowen disease is associated with internal malignancies.1,2,3,4 Many early papers reported such an association in 15-70% of cases. Some later reports supported an association of internal malignancies with Bowen disease that was associated with arsenic ingestion but not with Bowen disease from other causes. Most of the recent studies, with a larger number of cases and better scientific methods, have refuted any association; currently, Bowen disease is not believed to be a paraneoplastic condition.

Pathophysiology

Bowen disease is a form of intraepidermal carcinoma.  It may ultimately become an invasive squamous cell carcinoma.

Frequency

United States

In 1991, a study from Minnesota reported the annual average rate of Bowen disease as 14 cases per 100,000 whites. In 1994, a study from Hawaii reported a rate 10 times that, 142 cases per 100,000 whites.5

Mortality/Morbidity

Prognosis of Bowen disease is favorable, with less than 5% of cases advancing to invasive SCC, and metastases are even more rare.

Race

Bowen disease most commonly is reported in whites.

Sex

The ratio is approximately equal between males and females.

Age

Bowen disease has its highest incidence in the older age groups.

Clinical

History

Patients often present with an asymptomatic, slowly enlarging, erythematous, scaly patch or plaque. It may occur anywhere on the mucocutaneous surface. A delay in diagnosis often is encountered because the lesion is asymptomatic; early skin changes may be subtle and overlap with clinical features seen in many benign conditions such as tinea corporis, nummular eczema, and psoriasis.

Physical

Bowen disease presents as a single lesion in two thirds of cases. Lesions may appear on sun-exposed or covered skin. The head and neck are the most commonly affected anatomic locations, followed by the limbs. Lesions vary in size from a few millimeters to several centimeters in diameter. 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.6 Bowen disease also may occur on mucous membranes. When it arises on the glans penis, it is referred to as erythroplasia of Queyrat. See Erythroplasia of Queyrat (Bowen Disease of the Glans Penis) for more information on this topic.

Causes

  • Chronic UV radiation: Sun-exposed distribution of Bowen disease (over one half of lesions occur on the head, neck, and hands) implicates chronic sun damage as one factor in its formation.
  • Arsenic exposure: 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.
  • Human papilloma virus: Human papillomavirus type 16 is by far the most common subtype isolated from lesions of Bowen disease, although other subtypes, such as HPV 2, also have been found.
  • Other possible causes include genetic factors, trauma, other chemical carcinogens, and x-ray radiation. See the Medscape Skin Cancer Resource Center for more information.

More on Bowen Disease

Overview: Bowen Disease
Differential Diagnoses & Workup: Bowen Disease
Treatment & Medication: Bowen Disease
Follow-up: Bowen Disease
Multimedia: Bowen Disease
References
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References

  1. 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].

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

  3. 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].

  4. 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].

  5. 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].

  6. 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].

  7. 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].

  8. 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].

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

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

  11. 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].

  12. 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].

  13. Fernández-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].

  14. 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].

  15. Braathen LR, Szeimies RM, Basset-Seguin N, Bissonnette R, Foley P, Pariser D, 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].

  16. 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].

  17. 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].

  18. 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].

  19. 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.

  20. 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].

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

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

  23. 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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Further Reading

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Keywords

squamous cell carcinoma in situ, SCC, human papilloma virus 16, HPV 16, human papillomavirus 16

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Contributor Information and Disclosures

Author

Mark L Welch, MD, Clinical Assistant Professor, Department of Dermatology, Howard University; Assistant Professor, Department of Dermatology, Uniformed Services University of Health Sciences
Mark L Welch, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American Medical Association, and American Society for Dermatologic Surgery
Disclosure: Nothing to disclose.

Coauthor(s)

Theresa Conologue, DO, Physician, Department of Dermatology, National Capital Consortium, Walter Reed Army Medical Center
Theresa Conologue, DO is a member of the following medical societies: American Academy of Dermatology and Association of Military Dermatologists
Disclosure: Nothing to disclose.

Carrie A H Hall, MD, Resident Physician, National Capital Consortium Dermatology Residency Program, National Naval Medical Center
Carrie A H Hall, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Women's Dermatologic Society
Disclosure: Nothing to disclose.

Medical Editor

Kelly M Cordoro, MD, Fellow and Clinical Instructor, Department of Pediatric Dermatology, University of California at San Francisco; Assistant Professor (On Educational Leave), Assistant Program Director for Resident Medical Education, Department of Dermatology, University of Virginia 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.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Scott and White Clinic; Director Dermatology Residency Training Program, Scott and White 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: 3M Pharmaceutical Grant/research funds Other; Graceway Pharmaceuticals Grant/research funds Other

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 Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine 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.

 
 
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