Non melanoma skin cancer ---> squamous cell carcinoma ---> Early skin cancer ---> Bowen's disease
Bowen's disease (squamous cell carcinoma in situ) presents as a fixed red plaque and represents an intra epidermal squamous cell carcinoma.
Epidemiology
Bowen's disease may occur at any age but is rare before the age of 30; most patients are aged over 60 at presentation. In the UK, it occurs predominantly in women (85% of cases).
Pathology
A number of different factors have been implicated in the aetiology of Bowen's disease. The age group and body sites affected are suggestive of a relationship with chronic exposure to ultraviolet radiation.
Histologically, keratinocytes show loss of polarity, atypia and increased mitotic rate with involvement of the entire thickness of the epidermis from basal layer to stratum corneum. The basement membrane remains intact.
Clinical features
Bowen's disease presents as solitary or multiple, gradually enlarging, well-demarcated erythematous macules, papules or plaques. The lesions usually have an irregular border with surface crusting or scaling. Approximately 75% of lesions are on the lower legs. They are most often asymptomatic, but may bleed. In the uncircumcised male, the lesions can present as smooth, red, velvety plaques on the glans penis (erythroplasia of Queyrat).
Investigations
The diagnosis is suggested on the basis of clinical features.
Skin biopsy
Histology is required to confirm the diagnosis.
Management
Ablation of the lesion
Treatment options for Bowen's disease include cryotherapy, curettage and cautery, excision, laser (CO2, argon and Nd:YAG) and topical 5-fluorouracil (applied once or twice daily as 5% cream for up to 2 months). All have recurrence rates of up to 10% and no treatment modality appears to be superior.
Prognosis
If Bowen's disease is untreated, most studies suggest a 3% risk of progression to invasive squamous cell carcinoma. Up to 50% of patients have other previous or subsequent skin malignancies, most commonly basal cell carcinoma. Genital Bowen's disease carries a higher risk of invasive cancer.
Sunday, January 6, 2008
Bowen's disease
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5 comments:
Besides protection from the sun and regularly examinations, is there anything that can be done to decrease the likelihood of a recurrence? Diet or vitamins, for example?
Topical therapy of Bowen disease may result in a recurrence rate of 5–10%.
Recurrence is related to involvement of ill-defined lateral margins.
Close follow-up after treatment is required which may necessitate further biopsy.
There's no data supporting any specific role for either diet or vitamins in the prevention of recurrence.
Thanks for your quick response, which is very much appreciated. Would you mind explaining in detail what you mean by 'close follow-up'? And may I ask if you're a dermatologist, oncologist, or ...?
Follow-up of sufferers with history of Bowen’s disease is meaningful to determine recurrent disease and to watch for new primary lesions. Aways check for a new or unusual looking scaly skin patch that looks different from the skin around it.
It has been recommended to monitor cases with Bowen’s disease every 3 months for the first year after treatment, every 6 months during the second year, and annually thereafter. Your dermatologist may simply suggest that it is kept under observation in a clinic, or in some cases by yourself or by your GP.
# Get into the habit of checking your skin regularly for signs of Bowen’s disease.
* Flat, scaly, red and slightly raised red patches that may re-appear and grow very slowly.
* The edges of which are irregular but distinct from the surrounding skin.
* Though the patch may present no symptoms, it can occasionally be sore, irritated or bleed..
# If you notice anything new or unusual at the site of the treated lesion, see your doctor.
I'm a Health care professional.
Thank you!
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