Bowen's disease

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Bowen's disease
Bowens.jpg
ICD-10 D00-D09
ICD-9 230-234
DiseasesDB 1569

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Jesus Rosario Hernandez, M.D. [2].

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

It was named after Dr John T. Bowen, the doctor who first described it in 1912.

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.

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

Epidemiology and Demographics

Age

Bowen's disease may occur at any age in adults but is rare before the age of 30 years - most patients are aged over 60.

Gender

Bowen's disease occurs predominantly in women (70-85% of cases).

Diagnosis

Physical Examination

Bowen's disease typically presents as a gradually enlarging, well demarcated erythematous plaque with an irregular border and surface crusting or scaling.

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

Photodynamic therapy (PDT), 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.

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