Bowen’s Disease
What is Bowen’s Disease?
Bowen’s disease is carcinoma in situ (the transformed cells remain confined to the epidermis above the basement membrane) derived from epidermal keratinocytes. It can progress to squamous cell carcinoma. It appears as an erythematous scaling or crusted patch, which may slowly enlarge. Bowen’s disease may also occur on mucous membranes, such as the glans penis. In this location it is known as erythroplasia of Queyrat and appears as a moist, red, velvety plaque.
With what can Bowen’s Disease be confused?
Early Bowen’s Disease often appears as nummular eczema, and comes to clinical attention due to its lack of response to steroids. Other conditions such as tinea corporis, superficial basal cell carcinoma, actinic keratosis, Paget’s disease, and psoriasis may also be confused with Bowen’s Disease.
How is Bowen’s Disease diagnosed?
A skin biopsy is required to diagnose Bowen’s Disease.
How is Bowen’s Disease treated?
Topical therapy, such as the anti-metabolite 5-fluurouracil (5-FU), can be used for weeks to months. Brisk inflmmation will occur, possibly leading to erosion or ulceration. Imiquimod (Aldara) a topical immune response modifier, may also be effective. Photodynamic therapy (PDT) has been used as well.
Destructive modalities can also be used, such as curettage and electrodesiccation, cryotherapy, and laser removal. The downside of these approaches is that no specimen is obtained for pathology confirmation.
Surgical treatment is best suited for well-defined lesions. Simple excision with 4 mm margins is effective for small lesions that are not in difficult locations. Mohs micrographic surgery is a good choice for larger lesions or poorly demarcated ones. Recurrent lesions or those in areas where tissue sparing is vital, such as face, digits or genitals, are good candidates as well.
What is the prognosis for Bowen’s Disease?
Most cases of Bowen’s Disease can be effectively treated. As for any skin cancer, follow-up at frequent intervals is necessary, typically every 6 to 12 months. Full body exams should be conducted at these visits to search for new lesions or recurrence. Sunscreen and protective clothing should be used to prevent further sun-induced skin damage. Treatment may lead to scarring. Topical treatments, and destructive modalities that do not provide a specimen for pathology may be more likely to lead to recurrence, necessitating further treatment.
