Bowen's Disease

Bowen's Disease

BD was first recognised by John Bowen in 1912. It is a squamous cell carcinoma (SCC) in situ with the ability to spread laterally. BD is a full-thickness anaplasia of the epidermis where the keratinocytes are atypical and disorderly.  It occurs as a single lesion in two-thirds of cases, and typically presents as an asymptomatic, slowly enlarging, erythematous and scaly plaque.

The most commonly affected sites are the head and neck, followed by the limbs. It is much more common after the age of 60. There may be a relationship with chronic sun exposure but this is not always the case. There is up to a 20% risk of progression to invasive SCC14,15.

Bowen's Disease Epidemiology and Incidence

Incidence

  • In 1991, a study from Minnesota reported the annual average rate of BD as 14 cases per 100,000 whites; in 1994, a study from Hawaii reported a rate 10 times higher - 142 cases per 100,000 whites15.
  • Bowen's disease is most commonly witnessed in Caucasians.
  • In the UK, BD has a greater prevalence in females with 70-85% of the cases14.

Risk Factors

Risk factors for the development of BD include:

  • Age: BD increases in incidence with age, however it can occur at any age in adults. It is uncommon in adults under the age of 3014,15,16.
  • Individuals who are exposed to chronic UV radiation and arsenic may be at risk for development of BD14,15,16.
  • Human papilloma virus (HPV 16) is a known risk factor.
  • Other risk factors include skin trauma, genetic factors, carcinogens, and X-ray irradiation14,15,16.

Clinical Features of Bowen's Disease

  • A progressively enlarging well-demarcated erythematous plaque with an irregular border and surface crusting and scaling.
  • In the absence of defined ulceration the disease is often asymptomatic and hard to diagnose.
  • Lesions are mainly solitary but multiple lesions are seen in 10-20% of patients14

Treating Bowen's Disease

Options include:

  • Photodynamic therapy (PDT) - Metvix® - PDT.
  • Cryotherapy.
  • Surgical approaches:
    • Curettage and electrodesiccation
    • Excision and reconstructive surgery
  • Radiotherapy.
  • Topical therapies
    • 5- Fluorouracil.

For a more detailed explanation of these therapies click here (by clicking on this link you will be leaving this site - Galderma is not responsible for the content).

References