Bowen's disease

Bowen's disease
Classification and external resources
Bowen's disease as seen under a microscope
ICD-10	D04 (ILDS D04.L10)
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, it can be considered as an early stage or intraepidermal form of squamous cell carcinoma. It was named after Mark Bowen. Erythroplasia of Queyrat is a form of squamous cell carcinoma in situ arising on the glans or prepuce, possibly induced by HPV.^[2]

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.

This is a persistent progressive non-elevated red scaly or crusted plaque which is due to an intraepidermal carcinoma and is potentially malignant. The lesions may occur anywhere on the skin surface or on mucosal surfaces. Freezing, cauterization or diathermy coagulation is often effective treatment.

Histology

Bowen's disease is essentially equivalent to squamous cell carcinoma in situ. Atypical squamous cells proliferate through the whole thickness of the epidermis. The entire tumor is confined to the epidermis and does not invade into the dermis. The cells in Bowen's are often highly atypical under the microscope, and may in fact look more unusual than the cells of some invasive squamous cell carcinomas.

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 results have been noted with the use of imiquimod for Bowen's disease of the skin, including the penis (erythroplasia of Queyrat), although Imiquimod is not FDA approved for the treatment of squamous cell carcinoma.

Additional images

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References

1. ^ James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. ISBN 0-7216-2921-0.
2. ^ J Invest Dermatol 2000 Sep;115(3):396-401

External links

• Photo
• Histological slide