Bowen's Disease

Important
It is possible that the main title of the report Bowen's Disease is not the name you expected. Please check the synonyms listing to find the alternate name(s) and disorder subdivision(s) covered by this report.

Synonyms

• Intraepidermal Squamous cell Carcinoma
• Precancerous Dermatosis

Disorder Subdivisions

• None

Related Disorders List

Information on the following diseases can be found in the Related Disorders section of this report:

• Psoriasis
• Paget`s Disease of the Breast
• Malignant Melanoma

General Discussion

Bowen's Disease is characterized by a precancerous, slow growing skin malignancy. The major symptom is a red-brown, scaly or crusted patch on the skin which resembles psoriasis or dermatitis. It may occur on any part of the skin or in the mucous membranes.

Symptoms

The first sign of Bowen's Disease is a plaque located on or within the skin (intraepidermal). It is a scaly area which may be recognized as squamous cell carcinoma in the initial stage of development. Pinkish or brownish raised areas of skin (papules) appear. They are usually irregular in shape and covered with a light crusty covering which, when removed, shows an oozing red surface. Bowen's Disease may be confused with common skin disorders as psoriasis or other similar types of dermatitis. It is slow growing and responds well to immediate treatment, but if left untreated Bowen's Disease can result in skin cancer and eventually spread to other parts of the body.

Causes

The exact cause of Bowen's Disease is not known. Like many forms of skin cancer, chronic sun exposure may cause it to develop. Ingestion of arsenic can be associated with the occurrence of the disease in skin ares unexposed to light, or in the mucous membranes. Human papillomavirus 16 DNA is found repeatedly in Bowen's Disease lesions, suggesting that a slow virus is also a possible cause. (Slow viruses may stay dormant in humans for extended periods of time, then for reasons yet unknown, may unexplainably become reactivated. The role of heredity which may make a person susceptible to slow viruses is not well understood). In other cases, no cause can be determined.

Affected Populations

Bowen's Disease affects both males and females. However, when found in the genital area, women are affected three times as often as men. The disease may occur at any age but is very rare in children.

Related Disorders

Symptoms of the following disorders can be similar to those of Bowen's Disease. Comparisons may be useful for a differential diagnosis:

Psoriasis is a common chronic and recurrent skin disorder characterized by dry, well-circumscribed silvery gray scaling spots or plaques which usually appear on the scalp, elbows, or knees. Symptoms may begin gradually. Psoriasis characteristically involves the scalp, extremities, the back and buttocks with sharply outlined lesions consisting of red spots or plaques covered with scales that usually do not itch. These lesions may heal without scarring and hair growth near the plaques is not affected. In severe cases, Psoriasis lesions may appear in pustular form. General health usually is not affected, unless severe arthritis (psoriatic arthritis) or untreatable scaling develops. However, stress may be caused by the stigma of an unsightly skin disorder. (For more information on these disorders, choose "Psoriasis" as your search term in the Rare Disease Database.)

Paget's Disease of the Breast (which is not related to Paget's Disease of bone)is characterized by cancer of the nipples of the breast. It can occur in both men and women. The major symptoms include an oozy, crusty skin inflammation (dermatitis) of the nipple which is nearly always associated with glandular (adenocarcinoma) cancer of the breast. A form of Paget's Disease of the Breast also affects the genital area, primarily in women. This condition responds well to treatment when it occurs on the surface of the skin. In cases associated with carcinoma of the rectum, treatment may be more difficult.

Malignant Melanoma is a common form of skin cancer. It is marked by tumors of the pigmentation cells (melanocyte) of the skin. These tumors may appear in different sizes, shapes, and shades of color, and may spread to adjacent parts of the body. Tumors may also spread through the blood and lymph circulation to other organs. Early treatment of malignant Melanoma is essential in order to cure the disease.

Standard Therapies

Treatment of Bowen's Disease usually involves surgical removal of the malignancy. Carbon dioxide lasers or scraping and burning the area involved (curettage or electrodesiccation) are the most frequently used methods of removing surface skin lesions. Other types of growths require different types of surgery. Other treatment is symptomatic and supportive.

Investigational Therapies

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.

For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:

Tollfree: (800) 411-1222
TTY: (866) 411-1010
Email: prpl@cc.nih.gov

For information about clinical trials sponsored by private sources, contact:
www.centerwatch.com

References

TEXTBOOKS
Bennett JC, Plum F., eds. Cecil Textbook of Medicine. 20th ed. Philadelphia, PA: W.B. Saunders Co; 1996:1035, 2209-10.

Fauci AS, et al., eds. Harrison's Principles of Internal Medicine, 14th Ed. New York, NY: McGraw-Hill, Inc; 1998:303, 508.

Berkow R., ed. The Merck Manual-Home Edition. Whitehouse Station, NJ: Merck Research Laboratories; 1997:993.

Beers MH, Berkow R., eds. The Merck Manual, 17th ed. Whitehouse Station, NJ: Merck Research Laboratories; 1999:843.

REVIEW ARTICLES
Uezato H, et al., Detection of human papilloma virus type 56 in extragenital Bowen's disease. Acta Derm Venereol. 1999;79:311-13.

Cleary RK, et al., Perianal Bowen's disease and anal intraepithelial neoplasia: review of the literature. Dis Colon Rectum. 1999;42:945-51.

Fitzgerald DA., Cancer precursors. Semin Cutan Med Surg. 1998;17:108-13.

CLINICAL TRIALS
Lee JD, et al., Radionuclide therapy of skin cancers and Bowen's disease using a specially designed skin patch. J Nucl Med. 1997;38:697-702.


Morton CA, et al., Comparison of photodynamic therapy with cryotherapy in the treatment of Bowen's disease. Br J Dermatol. 1996;135:766-71.

JOURNAL ARTICLES
Sobha s, et al., Bowen's disease of the eyelid in a renal transplant recipient on immunosuppressants. Aust NZ J Ophthalmol. 1999;27:447.

Cox NH, et al., Guidelines for management of Bowen's disease. Br J Dermatol. 1999;141:633-41.

Kim HJ, et al., Bowen's diseases and basal cell carcinomas in a patient. J Dermatol. 1999;26:695-97.

Bell HK, et al., Bowen's disease--a retrospective review of clinical management. Clin Exp Dermatol. 1999;24:338-39.

Levine N., Irritated lesion. What does it mean when an inflamed scaly plaque becomes red-brown in color. Geriatrics. 1999;54:22.

Clavel CE, et al., Mucosal oncogenic human papillomaviruses and extragenital Bowen disease. Cancer. 1999;86:282-87.

Resources

Skin Cancer Foundation
245 Fifth Avenue
Suite 1403
New York, NY 10016
Fax: (212)725-5751
Tel: (800)754-6490
Email: info@skincancer.org
Internet: http://www.skincancer.org

American Cancer Society, Inc.
1599 Clifton Road NE
Atlanta, GA 30329
USA
Tel: (404)320-3333
Tel: (800)227-2345
Internet: http://www.cancer.org

NIH/National Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse
1 AMS Circle
Bethesda, MD 20892-3675
USA
Tel: (301)495-4484
Fax: (301)718-6366
Tel: (877)226-4267
TDD: (301)565-2966
Email: NIAMSinfo@mail.nih.gov
Internet: http://www.niams.nih.gov/Health_Info

National Cancer Institute
6116 Executive Blvd, MSC 8322, Room 3036A
Bethesda, MD 20892-8322
USA
Tel: (301)435-3848
Tel: (800)422-6237
TDD: (800)332-8615
Internet: http://www.cancer.gov

OncoLink: The University of Pennsylvania Cancer Center Resource
3400 Spruce Street
2 Donner
Philadelphia, PA 19104-4283
USA
Tel: (215)349-5445
Fax: (215)349-5445
Email: editors@oncolink.upenn.edu
Internet: http://www.oncolink.upenn.edu

Rare Cancer Alliance
1649 North Pacana Way
Green Valley, AZ 85614
USA
Tel: (520)625-5495
Fax: (615)526-4921
Email: sharon.lane@rare-cancer.org
Internet: http://www.rare-cancer.org

Genetic and Rare Diseases (GARD) Information Center
PO Box 8126
Gaithersburg, MD 20898-8126
Tel: (301)519-3194
Fax: (240)632-9164
Tel: (888)205-2311
TDD: (888)205-3223
Email: gardinfo@nih.gov
Internet: http://www.genome.gov/10000409

Friends of Cancer Research
2231 Crystal Drive
Suite 200
Arlington, VA 22202
Tel: (703)302-1503
Fax: (703)302-1568
Email: info@focr.org
Internet: http://www.focr.org

Wellness Community
919 18th Street N.W.
Suite 54
Washington, DC 20006
Tel: (202)659-9709
Fax: (202)659-9301
Tel: (888)793-9355
Email: help@thewellnesscommunity.org
Internet: http://www.thewellnesscommunity.org

Lance Armstrong Foundation
PO Box 161550
Austin, TX 78716-1150
Tel: (512)236-8820
Fax: (512)236-8482
Tel: (866)235-7205
Internet: http://www.livestrong.org

The information provided in this report is not intended for diagnostic purposes. It is provided for informational purposes only. NORD recommends that affected individuals seek the advice or counsel of their own personal physicians.

It is possible that the title of this topic is not the name you selected. Please check the Synonyms listing to find the alternate name(s) and Disorder Subdivision(s) covered by this report

This disease entry is based upon medical information available through the date at the end of the topic. Since NORD's resources are limited, it is not possible to keep every entry in the Rare Disease Database completely current and accurate. Please check with the agencies listed in the Resources section for the most current information about this disorder.

For additional information and assistance about rare disorders, please contact the National Organization for Rare Disorders at P.O. Box 1968, Danbury, CT 06813-1968; phone (203) 744-0100; web site www.rarediseases.org or email orphan@rarediseases.org

Last Updated:  2/23/2008
Copyright  1989, 2000 National Organization for Rare Disorders, Inc.

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