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 2402

New York, NY 10016

Tel: (212)725-5176

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

TDD: (866)228-4327

Internet: http://www.cancer.org



NIH/NationaI Institute of Arthritis and Musculoskeletal and Skin Diseases

Information Clearinghouse

One 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/



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

Email: cancergovstaff@mail.nih.gov

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)349-8895

Fax: (215)349-5445

Email: hampshire@uphs.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

Internet: http://www.rare-cancer.org



Genetic and Rare Diseases (GARD) Information Center

PO Box 8126

Gaithersburg, MD 20898-8126

Tel: (301)251-4925

Fax: (301)251-4911

Tel: (888)205-2311

TDD: (888)205-3223

Email: http://rarediseases.info.nih.gov/GARD/EmailForm.aspx

Internet: http://rarediseases.info.nih.gov/GARD



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



Cancer Support Community

919 18th Street N.W.

Suite 54

Washington, DC 20006

Tel: (202)659-9709

Fax: (202)659-9301

Tel: (888)793-9355

Internet: www.cancersupportcommunity.org



Lance Armstrong Foundation

2201 E. Sixth Street

Austin, TX 78702

Tel: (512)236-8820

Fax: (512)236-8482

Tel: (877)236-8820

Email: media@livestrong.org

Internet: http://www.livestrong.org