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Bowen's Disease

Bowen's disease

Definition

A superficial precancerous squamous cell cancer, slow growing (i.e. has not started spreading) skin malignancy.

Description

Red-brown, scaly or crusty patch on the skin that resembles psoriasis, dermatitis or eczema that can occur on any part of the body.

Demographics

Bowen's disease affects both males and females. Women are affected in the genital area three times as often as men. The disease can occur at any age, but is rare in children.

Causes and symptoms

The exact cause of Bowen's disease is unknown. Like many forms of cancer, long-term sun exposure may be a cause. The skin usually indicates sun damage, such as wrinkling, changes in pigmentation, and loss of elasticity. Ingestion of arsenic has been associated with cases of Bowen's disease found in skin areas unexposed to light or mucous membranes. Human papillomavirus 16 DNA is found repeatedly in Bowen's disease lesions, which suggests that this virus might be a cause. The role of heredity is not well understood. There are cases of Bowen's disease for which a cause cannot be determined.

Symptoms

The symptoms of Bowen's disease include:

  • plaque located on or within the skin (intraepidermal)
  • open sore that bleeds and crusts and persists for weeks
  • wart-like growth that crusts and occasionally bleeds
  • persistent, scaly red patch with irregular borders that sometimes crusts or bleeds
  • pinkish or brownish raised areas of skin

Diagnosis

Bowen's disease can be confused with the other common skin disorders, such as psoriasis or types of dermatitis. Paget's disease of the breast and malignant melanoma are other types of cancer which may be confused for Bowen's disease. A medical history, physical examination, and biopsy establish the diagnosis.

Clinical staging, treatments, and prognosis

Treatment usually involves surgical removal of the lesion. Curettage and cautery methods, which include carbon dioxide lasers, liquid nitrogen, and topical fluorouracil (5-FU) compose the most efficient treatment for management of small solitary lesions.

There can be difficulties with the liquid nitrogen, 5-FU (Efudex, fluoroplex), scraping and burning because Bowen's lesions can hide deep in pores, and cells may extend into the surrounding area where lesion is visible.

Clinical trials

Dr. Colin Morton and colleagues at the Western Infirmary in the UK have been developing a photodynamic therapy using topical 5-aminolaevulinic acid(5-ALA).

Dr. Lee and colleagues at the University College of Medicine in Korea have been developing a specially designed radioactive skin patch.

Prevention

As with most skin cancers, prolonged exposure to the sun can increase the risk of developing the disease.

Special concerns

All treatment options have a recurrence rate of 5 to 10%, and no treatment modality seems superior for all clinical situations.

Resources

BOOKS

Fauci, Anthony, S. Harrison's Principles of Internal Medicine, 14th Ed. New York, NY: McGraw Hill, Inc., 1998: 303, 548, 1099T.

PERIODICALS

Ahmed, I., J., S. Berth-Jones, Charles Holmes, C. J. O. Callaghan, and A. Ilcyhyshyn. "Comparison of cryotherapy with curettage in the treatment of Bowen's disease: a prospective study." British Journal of Dermatology (2000)143:759-766.

Bell, H. K. and L. E. Rhodes. "Bowen's diseasea retrospective review of clinical management." Clinical and Experimental Dermatology 24 (1999):336-339.

Chung, Y. L., J. D. Lee, D. Bang, J. B. Lee, K. B. Park, and M.G. Lee. "Treatment of Bowen's disease with a specially designed radioactive skin patch." European Journal Nuclear Medicine (July 2000)27(7):842-6.

Clavel, C. E., Valerie Pham Huu, Anne P. Durlach, Philippe L. Birembaut, Philippe M., Bernard, and Christian G. Deran-court. "Mucosal Oncogenic Human Papillomaviruses and Extragenital Bowen Disease." Cancer (July 1999)86: 282-287.

Cox, N. H."Bowen's disease: where now with therapeutic trials?" British Journal of Dermatology (2000)143:699-700.

Cox N. H., D. J. Eedy, C. A. Morton. "Guidelines for management of Bowen's disease. British Association of Dermatologists." British Journal of Dermatologists (October, 1999):633-4.

Morton, Colin, A., Colin Whitehurst, John H. McColl, James V. Moore, and Rona M. MacKie."Photodynamic Therapy for Large or Multiple Patches of Bowen Disease and Basal Cell Carcinoma." Archives Dermatology (March 2001)137:319-324.

ORGANIZATIONS

American Cancer Society, Inc. 1599 Clifton Road NE, Atlanta, GA 30329, (404)320-3333, <http://www.cancer.org>. The American Cancer Society (ACS) is a nationwide community-based voluntary health organization dedicated to eliminating cancer as a major health problem and the largest source of private, nonprofit cancer funds. The ACS hopes to prevent cancer, save lives, and diminish suffering from cancer, through research, education, advocacy, and service. 2 July 2001.

NIH/National Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse One AMS Circle, Bethesda, MD, 20892-3675.(301)495-4484. <http://www.nih.gov/niams>. The NIAMS conducts and supports basic, clinical, and epidemiologic research and research training and disseminates information on diseases that include many forms of arthritis and diseases of the musculoskeletal system and the skin. 2 July 2001.

NIH/National Cancer Institute (NCI) Office of Communications-Public Inquiries Office, Building 31, Rm 10A03, 9000 Rockville Pike, Bethesda, MD 20892.(800)422-6237. <http://www.cancer.gov.>. Specializes in different aspects of cancer which includes cancer biology, cancer control and population sciences, cancer epidemiology and genetics, cancer prevention, and cancer treatment and diagnosis. 2 July 2001.

National Organizations of Rare Disorders (NORD) PO Box8923, Fairfield, CT, 06812-8923, (800)999-6673; <http://www.rarediseases.org.>. NORD is a voluntary health organization dedicated to helping people with rare diseases and assisting the organizations that serve them. 2 July 2001.

Skin Cancer Foundation 245 Fifth Avenue, Suite 1403, New York, NY 10016.(212)725-5176; <http://www.skincancer.org.> National and international organization that is concerned exclusively with skin cancer. 2 July 2001.

OTHER

Skincancerinfor.com Detailed summary of information about Bowen's disease. <http://www.skincancerinfo.com/sectionc/bowen.html>. 2 July 2001.

Laura Ruth, Ph.D.

KEY TERMS

Cancer

General term for abnormally growing (malignant) cells.

Dermatitis

Inflammation of the skin that may be due to an allergic reaction.

Melanoma

Abnormal growth in melanin cells which are most commonly found in the skin or in the eye.

Paget's disease of the breast

Cancer of breast nipples which occurs in both men and women. Paget's is characterized by oozy and crusty skin inflammation (dermatitis).

Psoriasis

Common inherited condition that is characterized by reddish, slivery-scaled maculopapules, predominantly on the elbows, knees, scalp, and trunk.

Squamous cell carcinoma

Type of skin cancer

QUESTIONS TO ASK THE DOCTOR

  • How do I know I have Bowen's disease rather than psoriasis, Paget's disease, dermatitis or another skin cancer?
  • Is surgical removal of the affected skin area the best treatment?
  • What other treatments for Bowen's disease are available other than surgical removal?

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Bowen's disease

Bowen's disease (boh-ĕnz) n. a type of in-situ carcinoma of the squamous epidermal cells of the skin that does not spread to the basal layers. [ J. T. Bowen (1857–1941), US dermatologist]

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