eMedicine Specialties > Dermatology > Malignant Neoplasms

Bowen Disease: Treatment & Medication

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

Treatment

Medical Care

  • Topical therapy
    • Administration of 5-fluorouracil topically under occlusion, following the use of a keratolytic or cryotherapy, or by iontophoresis (an electrogradient-driven chemical delivery system) has been used to effectively treat Bowen disease.7,8,9,10
    • Imiquimod 5% cream,11,12 a topical immune response modifier, applied 3-7 d/wk appears to be a successful treatment option for Bowen disease in multiple body sites. Two reports indicate sustained clearance with at least 19 months disease-free follow-up after treatment of perianal Bowen disease with single-agent therapy using imiquimod 5% cream. Topical treatment for perianal Bowen disease may minimize the risk of scarring, poor wound healing, and functional impairment.
    • Also note, however, that a cautionary report describes Bowen disease of the scalp treated with imiquimod that evolved into invasive SCC.13
  • Consider x-ray or grenz-ray radiation therapy for poor surgical candidates or patients with multiple lesions.14
  • In the last decade, photodynamic therapy (PDT) has shown promise in the treatment of superficial carcinomas, such as Bowen disease.15,16 PDT involves the introduction of a photosensitizing agent into the body, which is retained preferentially by the tumor cells. Then, a light source is used to stimulate the photosensitizing agent, causing the release of toxins and leading to the destruction of the tumor.

Surgical Care

  • Simple excision with conventional margins
    • This surgery is the most common and preferred treatment for smaller lesions and those not in problematic areas, such as the face and digits.
    • Although lesions are typically well demarcated, the actual extent of the disease may be well beyond the clinical margins. For this reason, the excision should be made at least 4 mm outside the clinical margin.
  • Mohs micrographic surgery17
    • This is an excellent method for larger lesions, recurrent lesions, or those in areas where tissue sparing is vital. Mohs micrographic surgery uses the systematic surgical removal of skin cancers with very small margins of normal tissue followed by frozen section examination of nearly 100% of the tissue margin.
    • It offers the highest cure rate of all treatment modalities, and, because relatively thin layers are taken only in areas of proven tumor, it is a tissue-sparing procedure.
  • Curettage and electrodesiccation, cryotherapy, and carbon dioxide laser ablation18
    • These are blind surgical methods (no pathologic confirmation of removal) that are established treatment modalities for Bowen disease.
    • As compared with excision and Mohs surgery, they are less likely to remove tumors that are present down in the adnexal structures.

The Medscape Dermatologic Surgery Resource Center may be of interest.

Medication

The goals of therapy are to reduce morbidity and to prevent complications.

Antineoplastic agents

Topical agents that may be used in the management of Bowen disease.


5-Fluorouracil (Efudex, Carac, Adrucil, Fluoroplex)

5-Fluorouracil administered topically under occlusion, following the use of keratolytic or cryotherapy, or by iontophoresis (an electrogradient-driven chemical delivery system), can be used. Interferes with DNA synthesis by blocking methylation of deoxyuridylic acid and inhibits thymidylate synthetase, which subsequently reduces cell proliferation.

Adult

Only 5% strength recommended; apply bid, sparingly to cover lesions (minimum 3 wk); therapy may be required for 10-12 wk

Pediatric

Administer as in adults

Documented hypersensitivity; potentially serious infections

Pregnancy

X - Contraindicated; benefit does not outweigh risk

Precautions

Incidence of inflammatory reactions may occur with occlusive dressings; porous gauze dressing may be applied for cosmetic reasons without increase in reaction


Imiquimod (Aldara)

Precise mechanism of action for treatment of Bowen disease is unknown. May increase tumor infiltration of lymphocytes, dendritic cells, and macrophages. Indicated when surgical methods are not appropriate.

Adult

Apply cream to treatment area (including 1 cm of skin surrounding tumor) 3-7 d/wk for up to 16 wk; leave on for at least 8 h, then wash area

Pediatric

Not established

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Mandatory follow-up to ensure treatment response; may cause redness, swelling, and sore development at application site; may cause itching or burning

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. 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].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

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

[ CLOSE WINDOW ]

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.

 
 
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.