Bowens Disease
Bowen's disease of the medial canthus and lower eyelid.
Bowen's disease of the hand on an elderly lady. Image used courtesy of Stuart Waterson and the University of Aberdeen.
Features
Bowen's disease is defined as a persistent, progressive, non-elevated, red, scaly or crusted plaque which is due to an intra-epidermal carcinoma and is potentially malignant. Bowen's disease is squamous cell carcinoma in situ. It can occur on any part of the skin or mucosal surface, but is commonly found on the legs. If left untreated, Bowen's disease will become invasive disease.
Clinically, it appears as a flat, red, raised lesion with clearly defined margin and irregular border. It is associated with white or yellow scaling of the skin, which does not bleed if the scale is removed.
Incidence
One American study found an incidence of 14/100,000 per year in the white population. A study conducted in Hawaii reported a rate of 142/100,000 in a similar group. Bowen's disease is more commonly reported in white people, with no difference between men and women.
Aetiology
A number of factors have been implicated. Sunlight exposure is confirmed as the most common causative factor, although contact with Arsenic is also a strongly predisposing factor. Other risk factors include increasing age and agricultural work (perhaps due to increased sunlight and chemical exposure in this group).
Differential Diagnosis
Psoriasis. Actinic keratosis. Basal cell carcinoma.
Treatment
Excision is the treatment of choice. Local application of 5-fluorouracil (Efudix) and cryotherapy in small lesions are also confirmed methods of treatment.
Photodynamic therapy (PDT) is not a first line treatment and is currently on trial. PTD involves giving a photosensitising drugs and then applying laser or other high energy light to the lesion.
