Bowen disease, also known as squamous cell carcinoma in situ, is a type of skin cancer that affects the outer layers of the skin. It is characterized by abnormal, precancerous skin cells that have not yet invaded the deeper layers of the skin.
These abnormal cells typically appear as red, scaly patches on the skin and can be found on any part of the body but are most commonly found on sun-exposed areas such as the face, arms, and legs.
It is a slow-growing condition and may take months or years to develop. If it forms an ulcer, it is typically a sign that the condition has progressed to squamous cell carcinoma.
Epidemiology
Bowen disease is more likely to occur in individuals over 60 with a history of prolonged sun exposure or weak immune systems. Bowen disease’s exact incidence and prevalence are not well-established, as it is not a common type of cancer, and data on it is limited. The mortality rate for Bowen disease is generally low, as it is usually slow-growing cancer that can be effectively treated with surgery if identified early.
However, if left untreated, it can progress to a more aggressive form of skin cancer called squamous cell carcinoma, which can be more challenging to treat and may have a higher mortality rate.
Anatomy
Pathophysiology
The pathophysiology of Bowen disease involves the abnormal growth and proliferation of keratinocytes, the cells that make up the outer layer of the skin. This abnormal growth is typically caused by DNA damage in these cells, caused by various factors such as sun ultraviolet (UV) radiation, exposure to certain chemicals, or a weak immune system. When DNA is damaged, it can lead to errors in the genetic code replicated when cells divide.
These errors can cause the affected cells to grow and divide uncontrolled and abnormally, leading to the development of a scaly, red patch on the skin, a characteristic feature of Bowen disease. Histopathologically, Bowen disease is characterized by abnormal keratinocytes in the epidermis, the outer layer of the skin. These cells may be larger and more irregular in shape than normal keratinocytes.
They may also show signs of atypia, which refers to abnormal changes in their size, shape, and organization. In addition to these changes, the dermis, the layer of tissue beneath the epidermis, may show signs of inflammation. Overall, the histopathological features of Bowen disease are consistent with those of other types of squamous cell carcinoma. However, the disease is typically less aggressive and has a better prognosis than other forms of skin cancer.
Etiology
Bowen disease, also known as squamous cell carcinoma in situ, is a type of skin cancer that affects the outer layers of the skin. It is most commonly caused by exposure to ultraviolet (UV) radiation from the sun or from tanning beds. However, other factors can increase the risk of developing Bowen disease, including age; the risk increases with age, especially over 60.
Individuals with fair skin are more prone to developing the disease due to a lack of melanin, which helps protect the skin from UV radiation. Individuals with weak immune systems, such as HIV or AIDS, are more prone to developing Bowen disease. Some medications, such as those used to treat psoriasis, increase the risk. Individuals with a history of skin cancer or family history are at risk of developing Bowen disease.
Genetics
Prognostic Factors
The prognosis for Bowen disease is generally excellent, especially if the condition is diagnosed and treated in its early stages. In most cases, Bowen disease can be completely cured with proper treatment.
However, if the condition is left untreated, it can progress to squamous cell carcinoma, a more severe form of skin cancer. The prognosis for squamous cell carcinoma is generally good, but it is more challenging to treat than Bowen disease and can be more aggressive.
Clinical History
It typically presents as a persistent, red, scaly patch or plaque on the skin that may be itchy or tender. It is most commonly found on sun-exposed areas of the body, such as the face, neck, arms, and legs, but it can also occur on other areas of the body. The affected skin may sometimes become thickened or develop small, red bumps or nodules.
Most individuals with Bowen disease have a single lesion, but some may have multiple lesions, which occurs in about 10-20% of cases. In rare cases, Bowen disease can progress to invasive squamous cell carcinoma, a more aggressive form of skin cancer, if it is not treated.
Physical Examination
Physical Examination
Bowen disease lesions typically appear red, scaly, and velvety, distinguished by their irregular, sharply demarcated borders in areas with no keratinization. In areas where there is keratinization, the redness may be covered by scaling. The patch may be oval or circular and range from a few millimeters to several centimeters.
The lesions may appear differently depending on the location and conditions of the affected skin, such as areas where the skin rubs together or areas that are moist or have thickened skin. They may become thicker and crusty, or develop fissures or ulcers. In some cases, the lesions may also be pigmented, particularly in the genital area or on the nails, and may resemble melanoma.
These lesions may also appear on mucous membranes, such as on the glans penis, where they are known as erythroplasia of Queyrat and typically present as red, moist, velvety or smooth plaques.
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Differential Diagnoses
Differential Diagnoses
Actinic Keratosis
Basal cell carcinoma
Benign lichenoid keratosis
Cutaneous squamous cell carcinoma
Extramammary Paget Disease
Melanoma
Seborrheic keratosis
Lichen sclerosus
Plaque Psoriasis
Tinea Corporis
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
The treatment approach for Bowen disease depends on the size, location, and severity of the affected area. In most cases, the first line of treatment is the surgical removal of the affected skin tissue, usually done using a local anesthetic. Other treatment options may include cryotherapy, topical chemotherapy, or laser therapy.
If the affected area is small and superficial, it may be possible to treat it with cryotherapy or topical chemotherapy. These treatments are less invasive than surgery and may be suitable for individuals with immunocompromised states and comorbidities.
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Bowen disease, also known as squamous cell carcinoma in situ, is a type of skin cancer that affects the outer layers of the skin. It is characterized by abnormal, precancerous skin cells that have not yet invaded the deeper layers of the skin.
These abnormal cells typically appear as red, scaly patches on the skin and can be found on any part of the body but are most commonly found on sun-exposed areas such as the face, arms, and legs.
It is a slow-growing condition and may take months or years to develop. If it forms an ulcer, it is typically a sign that the condition has progressed to squamous cell carcinoma.
Bowen disease is more likely to occur in individuals over 60 with a history of prolonged sun exposure or weak immune systems. Bowen disease’s exact incidence and prevalence are not well-established, as it is not a common type of cancer, and data on it is limited. The mortality rate for Bowen disease is generally low, as it is usually slow-growing cancer that can be effectively treated with surgery if identified early.
However, if left untreated, it can progress to a more aggressive form of skin cancer called squamous cell carcinoma, which can be more challenging to treat and may have a higher mortality rate.
The pathophysiology of Bowen disease involves the abnormal growth and proliferation of keratinocytes, the cells that make up the outer layer of the skin. This abnormal growth is typically caused by DNA damage in these cells, caused by various factors such as sun ultraviolet (UV) radiation, exposure to certain chemicals, or a weak immune system. When DNA is damaged, it can lead to errors in the genetic code replicated when cells divide.
These errors can cause the affected cells to grow and divide uncontrolled and abnormally, leading to the development of a scaly, red patch on the skin, a characteristic feature of Bowen disease. Histopathologically, Bowen disease is characterized by abnormal keratinocytes in the epidermis, the outer layer of the skin. These cells may be larger and more irregular in shape than normal keratinocytes.
They may also show signs of atypia, which refers to abnormal changes in their size, shape, and organization. In addition to these changes, the dermis, the layer of tissue beneath the epidermis, may show signs of inflammation. Overall, the histopathological features of Bowen disease are consistent with those of other types of squamous cell carcinoma. However, the disease is typically less aggressive and has a better prognosis than other forms of skin cancer.
Bowen disease, also known as squamous cell carcinoma in situ, is a type of skin cancer that affects the outer layers of the skin. It is most commonly caused by exposure to ultraviolet (UV) radiation from the sun or from tanning beds. However, other factors can increase the risk of developing Bowen disease, including age; the risk increases with age, especially over 60.
Individuals with fair skin are more prone to developing the disease due to a lack of melanin, which helps protect the skin from UV radiation. Individuals with weak immune systems, such as HIV or AIDS, are more prone to developing Bowen disease. Some medications, such as those used to treat psoriasis, increase the risk. Individuals with a history of skin cancer or family history are at risk of developing Bowen disease.
The prognosis for Bowen disease is generally excellent, especially if the condition is diagnosed and treated in its early stages. In most cases, Bowen disease can be completely cured with proper treatment.
However, if the condition is left untreated, it can progress to squamous cell carcinoma, a more severe form of skin cancer. The prognosis for squamous cell carcinoma is generally good, but it is more challenging to treat than Bowen disease and can be more aggressive.
It typically presents as a persistent, red, scaly patch or plaque on the skin that may be itchy or tender. It is most commonly found on sun-exposed areas of the body, such as the face, neck, arms, and legs, but it can also occur on other areas of the body. The affected skin may sometimes become thickened or develop small, red bumps or nodules.
Most individuals with Bowen disease have a single lesion, but some may have multiple lesions, which occurs in about 10-20% of cases. In rare cases, Bowen disease can progress to invasive squamous cell carcinoma, a more aggressive form of skin cancer, if it is not treated.
Physical Examination
Bowen disease lesions typically appear red, scaly, and velvety, distinguished by their irregular, sharply demarcated borders in areas with no keratinization. In areas where there is keratinization, the redness may be covered by scaling. The patch may be oval or circular and range from a few millimeters to several centimeters.
The lesions may appear differently depending on the location and conditions of the affected skin, such as areas where the skin rubs together or areas that are moist or have thickened skin. They may become thicker and crusty, or develop fissures or ulcers. In some cases, the lesions may also be pigmented, particularly in the genital area or on the nails, and may resemble melanoma.
These lesions may also appear on mucous membranes, such as on the glans penis, where they are known as erythroplasia of Queyrat and typically present as red, moist, velvety or smooth plaques.
Differential Diagnoses
Actinic Keratosis
Basal cell carcinoma
Benign lichenoid keratosis
Cutaneous squamous cell carcinoma
Extramammary Paget Disease
Melanoma
Seborrheic keratosis
Lichen sclerosus
Plaque Psoriasis
Tinea Corporis
The treatment approach for Bowen disease depends on the size, location, and severity of the affected area. In most cases, the first line of treatment is the surgical removal of the affected skin tissue, usually done using a local anesthetic. Other treatment options may include cryotherapy, topical chemotherapy, or laser therapy.
If the affected area is small and superficial, it may be possible to treat it with cryotherapy or topical chemotherapy. These treatments are less invasive than surgery and may be suitable for individuals with immunocompromised states and comorbidities.
medtigo
Bowen Disease
Updated :
January 9, 2023
Bowen disease, also known as squamous cell carcinoma in situ, is a type of skin cancer that affects the outer layers of the skin. It is characterized by abnormal, precancerous skin cells that have not yet invaded the deeper layers of the skin.
These abnormal cells typically appear as red, scaly patches on the skin and can be found on any part of the body but are most commonly found on sun-exposed areas such as the face, arms, and legs.
It is a slow-growing condition and may take months or years to develop. If it forms an ulcer, it is typically a sign that the condition has progressed to squamous cell carcinoma.
Bowen disease is more likely to occur in individuals over 60 with a history of prolonged sun exposure or weak immune systems. Bowen disease’s exact incidence and prevalence are not well-established, as it is not a common type of cancer, and data on it is limited. The mortality rate for Bowen disease is generally low, as it is usually slow-growing cancer that can be effectively treated with surgery if identified early.
However, if left untreated, it can progress to a more aggressive form of skin cancer called squamous cell carcinoma, which can be more challenging to treat and may have a higher mortality rate.
The pathophysiology of Bowen disease involves the abnormal growth and proliferation of keratinocytes, the cells that make up the outer layer of the skin. This abnormal growth is typically caused by DNA damage in these cells, caused by various factors such as sun ultraviolet (UV) radiation, exposure to certain chemicals, or a weak immune system. When DNA is damaged, it can lead to errors in the genetic code replicated when cells divide.
These errors can cause the affected cells to grow and divide uncontrolled and abnormally, leading to the development of a scaly, red patch on the skin, a characteristic feature of Bowen disease. Histopathologically, Bowen disease is characterized by abnormal keratinocytes in the epidermis, the outer layer of the skin. These cells may be larger and more irregular in shape than normal keratinocytes.
They may also show signs of atypia, which refers to abnormal changes in their size, shape, and organization. In addition to these changes, the dermis, the layer of tissue beneath the epidermis, may show signs of inflammation. Overall, the histopathological features of Bowen disease are consistent with those of other types of squamous cell carcinoma. However, the disease is typically less aggressive and has a better prognosis than other forms of skin cancer.
Bowen disease, also known as squamous cell carcinoma in situ, is a type of skin cancer that affects the outer layers of the skin. It is most commonly caused by exposure to ultraviolet (UV) radiation from the sun or from tanning beds. However, other factors can increase the risk of developing Bowen disease, including age; the risk increases with age, especially over 60.
Individuals with fair skin are more prone to developing the disease due to a lack of melanin, which helps protect the skin from UV radiation. Individuals with weak immune systems, such as HIV or AIDS, are more prone to developing Bowen disease. Some medications, such as those used to treat psoriasis, increase the risk. Individuals with a history of skin cancer or family history are at risk of developing Bowen disease.
The prognosis for Bowen disease is generally excellent, especially if the condition is diagnosed and treated in its early stages. In most cases, Bowen disease can be completely cured with proper treatment.
However, if the condition is left untreated, it can progress to squamous cell carcinoma, a more severe form of skin cancer. The prognosis for squamous cell carcinoma is generally good, but it is more challenging to treat than Bowen disease and can be more aggressive.
It typically presents as a persistent, red, scaly patch or plaque on the skin that may be itchy or tender. It is most commonly found on sun-exposed areas of the body, such as the face, neck, arms, and legs, but it can also occur on other areas of the body. The affected skin may sometimes become thickened or develop small, red bumps or nodules.
Most individuals with Bowen disease have a single lesion, but some may have multiple lesions, which occurs in about 10-20% of cases. In rare cases, Bowen disease can progress to invasive squamous cell carcinoma, a more aggressive form of skin cancer, if it is not treated.
Physical Examination
Bowen disease lesions typically appear red, scaly, and velvety, distinguished by their irregular, sharply demarcated borders in areas with no keratinization. In areas where there is keratinization, the redness may be covered by scaling. The patch may be oval or circular and range from a few millimeters to several centimeters.
The lesions may appear differently depending on the location and conditions of the affected skin, such as areas where the skin rubs together or areas that are moist or have thickened skin. They may become thicker and crusty, or develop fissures or ulcers. In some cases, the lesions may also be pigmented, particularly in the genital area or on the nails, and may resemble melanoma.
These lesions may also appear on mucous membranes, such as on the glans penis, where they are known as erythroplasia of Queyrat and typically present as red, moist, velvety or smooth plaques.
Differential Diagnoses
Actinic Keratosis
Basal cell carcinoma
Benign lichenoid keratosis
Cutaneous squamous cell carcinoma
Extramammary Paget Disease
Melanoma
Seborrheic keratosis
Lichen sclerosus
Plaque Psoriasis
Tinea Corporis
The treatment approach for Bowen disease depends on the size, location, and severity of the affected area. In most cases, the first line of treatment is the surgical removal of the affected skin tissue, usually done using a local anesthetic. Other treatment options may include cryotherapy, topical chemotherapy, or laser therapy.
If the affected area is small and superficial, it may be possible to treat it with cryotherapy or topical chemotherapy. These treatments are less invasive than surgery and may be suitable for individuals with immunocompromised states and comorbidities.
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