What is Bowen’s Disease?

Bowen’s disease is a neoplastic superficial skin disease having the potential for a major lateral proliferation. In the year 1912, an American dermatologist named Dr. John T. Bowen first coined and described the disease. Being basically equivalent to squamous cell carcinoma in situ, the whole tumor is limited only to the epidermis. However, if left untreated, Bowen disease may eventually advance to an invasive type of squamous cell carcinoma.

The carcinogenesis of this disease is most likely due to a multifactorial origin which includes chronic sun damage, arsenic exposure, Human papilloma virus, immunosuppression, genetics, trauma, chemical carcinogens and radiation.

Affected individuals often exhibit with an asymptomatic, gradually growing, reddish, well-defined scaly plaques occurring anywhere on the mucocutaneous surfaces and on sun-exposed areas. These plaques may likely become hyperkeratotic, scabbed, cracked and ulcerated. There is a single lesion in about two thirds of cases.

The projection is favorable and is much better than the invasive type of squamous cell carcinoma since Bowen’s disease is just a superficial carcinoma in situ and has not invaded yet the dermal layer. Therapeutic option depends on various dynamics such as lesional size, number, location, degree of functional impairment and cost. Doctors favor the utilization of photodynamic therapy, freezing and local chemotherapy with 5-fluorouracil on top of surgical excision. For smaller lesions, the most usual and favored treatment is simple excision with conventional margins. Even if the lesions characteristically are well-demarcated, the actual magnitude might be beyond the clinical margins. For that cause, the cutting out is made at least 4 mm past the margin. In cases where the lesions are larger and are poorly defined and are located on areas where tissue sparing is imperative, the excellent approach to be used is Mohs micrographic surgery. Remember that majority of the treatments have risk of disease recurrence, so a follow-up check-up after 6 to 12 months for evaluation is suggested.

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Bowen’s Disease Pictures

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