Bowen's disease
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sara Mohsin, M.D.[2] Jesus Rosario Hernandez, M.D. [3]
Synonyms and keywords: Bowen's carcinoma; squamous cell carcinoma in situ of skin; intraepidermal carcinoma skin
Overview
In medicine (dermatology), Bowen's disease (BD) is a sunlight-induced skin disease, considered either as an early stage or intraepidermal form of squamous cell carcinoma.
Historical Perspective
- In 1912, Dr John T. Bowen was the first one to describe this disease, hence, it is named after him
Pathophysiology
Microscopic Pathology
The cells in Bowen's are extremely unusual or atypical under the microscope and in many cases look worse under the microscope than the cells of many outright and invading squamous cell carcinomas. The degree of atypia (strangeness, unusualness) seen under the microscope best tells how cells may behave should they invade another portion of the body.
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Causes
Common Causes
Causes of BD include solar damage, arsenic, immunosuppression (including AIDS), viral infection (human papillomavirus or HPV) and chronic skin injury and dermatoses.
Causes in Alphabetical Order
- Arsenic
- Chronic skin injury
- Dermatoses
- Immunosuppression
- Including AIDS
- Solar damage
- Viral infection
Epidemiology and Demographics
Age
- Bowen's disease can affect adults of any age, most commonly involves older patients in their 60s or 70s
- It is rare before the age of 30 years
Gender
- Bowen's disease occurs predominantly in women (70-85% of cases)
Diagnosis
Symptoms
- It usually appears as one or more skin patches with following characteristics:[1]
- Non-healing
- Irregular edges
- Scaly or crsuty
- Red or pink
- Upto a few centimetres across
- Flat or raised
- Itchy (but not all the time)
Physical Examination
Bowen's disease typically presents as a gradually enlarging, well demarcated erythematous plaque with an irregular border and surface crusting or scaling.
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Bowen's disease
Skin
Any site may be affected, although involvement of palms or soles is uncommon. A persistent progressive non-elevated red scaly or crusted plaque which is due to an intradermal carcinoma and is potentially malignant. Atypical squamous (resembling fish scales) cells proliferate through the whole thickness of the epidermis. The lesions may occur anywhere on the skin surface or on mucosal surfaces.
Extremities
About three-quarters of patients have lesions on the lower leg (60-85%), usually in previously or presently sun-exposed areas of skin.
Skinfolds
Genitourinary system=
Treatment
Surgery and Device Based Therapy
- Excision
- Cryotherapy (freezing) or local chemotherapy (with 5-fluorouracil) are favored by some clinicians over excision
- Cauterization or diathermy coagulation are often effective treatments as well.[2]
- Photodynamic therapy (PDT)[3][4][5][6][7][8]
- Radiation therapy[9][10][11][12][13][14]
References
- ↑ "Bowen's disease - NHS".
- ↑ Neubert T, Lehmann P (2008). "Bowen's disease - a review of newer treatment options". Ther Clin Risk Manag. 4 (5): 1085–95. PMC 2621408. PMID 19209288.
- ↑ Wong TW, Sheu HM, Lee JY, Fletcher RJ (2001). "Photodynamic therapy for Bowen's disease (squamous cell carcinoma in situ) of the digit". Dermatol Surg. 27 (5): 452–6. PMID 11359493.
- ↑ Britton JE, Goulden V, Stables G, Stringer M, Sheehan-Dare R (2005). "Investigation of the use of the pulsed dye laser in the treatment of Bowen's disease using 5-aminolaevulinic acid phototherapy". Br J Dermatol. 153 (4): 780–4. doi:10.1111/j.1365-2133.2005.06830.x. PMID 16181460.
- ↑ Kang HK, Yun JH, Son YM, Roh JY, Lee JR (2014). "Photodynamic Therapy for Bowen's Disease of the Vulva Area". Ann Dermatol. 26 (2): 241–5. doi:10.5021/ad.2014.26.2.241. PMC 4037679. PMID 24882981.
- ↑ Dijkstra AT, Majoie IM, van Dongen JW, van Weelden H, van Vloten WA (2001). "Photodynamic therapy with violet light and topical 6-aminolaevulinic acid in the treatment of actinic keratosis, Bowen's disease and basal cell carcinoma". J Eur Acad Dermatol Venereol. 15 (6): 550–4. PMID 11843215.
- ↑ Harth Y, Hirshowitz B, Kaplan B (1998). "Modified topical photodynamic therapy of superficial skin tumors, utilizing aminolevulinic acid, penetration enhancers, red light, and hyperthermia". Dermatol Surg. 24 (7): 723–6. PMID 9693665.
- ↑ de Haas ER, de Vijlder HC, Sterenborg HJ, Neumann HA, Robinson DJ (2008). "Fractionated aminolevulinic acid-photodynamic therapy provides additional evidence for the use of PDT for non-melanoma skin cancer". J Eur Acad Dermatol Venereol. 22 (4): 426–30. doi:10.1111/j.1468-3083.2007.02445.x. PMID 18031503.
- ↑ Anna Z, John K, Maria T, George K, Ivelina B, Ioanna K; et al. (2012). "The potential role of radiation therapy in Bowen's disease: a review of the current literature". Rev Recent Clin Trials. 7 (1): 42–6. PMID 21864250.
- ↑ Lukas VanderSpek LA, Pond GR, Wells W, Tsang RW (2005). "Radiation therapy for Bowen's disease of the skin". Int J Radiat Oncol Biol Phys. 63 (2): 505–10. doi:10.1016/j.ijrobp.2005.02.024. PMID 16168842.
- ↑ Herman JM, Pierce LJ, Sandler HM, Griffith KA, Jabbari S, Hiniker SM; et al. (2008). "Radiotherapy using a water bath in the treatment of Bowen's disease of the digit". Radiother Oncol. 88 (3): 398–402. doi:10.1016/j.radonc.2008.05.025. PMID 18571754.
- ↑ Goodman CR, DeNittis A (2017). "Photon irradiation using a water bath technique for treatment of confluent carcinoma in situ of the hand, digits, and nail bed: a case report". J Med Case Rep. 11 (1): 86. doi:10.1186/s13256-017-1233-3. PMC 5372342. PMID 28356127.
- ↑ Hunt WT, Cameron A, Craig P, de Berker DA (2013). "Multiple-digit periungual Bowen's disease: a novel treatment approach with radiotherapy". Clin Exp Dermatol. 38 (8): 857–61. doi:10.1111/ced.12149. PMID 23937119.
- ↑ Dupree MT, Kiteley RA, Weismantle K, Panos R, Johnstone PA (2001). "Radiation therapy for Bowen's disease: lessons for lesions of the lower extremity". J Am Acad Dermatol. 45 (3): 401–4. doi:10.1067/mjd.2001.116581. PMID 11511838.