1. Pigmented Bowen’s Disease
Dr Ian Katz, March 2013
www.southernsunpathology.com.au

2. What is Bowen’s disease?
• It is squamous cell carcinoma (SCC) that is still
within the epidermis
– i.e. is not invasive into the dermis

3. My classification of SCC
• Possibly two different pathways
– Actinic pathway
– Bowen’s pathway

4. Actinic Pathway
• Actinic keratosis
• ?Intermediate lesion
• Intraepidermal SCC
• ? Early invasive SCC
• SCC

5. Bowen’s pathway
• ? Precursor or early lesion
• Bowen’s disease
• ?possible invasive BD
• Invasive BD type SCC

6. Invasive Bowen’s disease
• Can be really difficult to tell when there is
early invasion
• Often extensive follicular involvement
– Careful with topical therapy in hair-bearing skin
• Invasive BD type SCC said to have worse
prognosis than regular SCC for the same depth
(difficult to find this reference)

7. Who was Bowen
• John T Bowen, an American dermatologist
• 1857–1940

8. The case
• 80 yo old man
• Lots of skin cancers
• Scaly, lightly pigmented lesion on right
forearm
• No idea how long it had been there

11. Dermatoscopic features
• Scaly surface
• Pigment but no network
• Dot vessels
• All highly suggestive of pigmented Bowen’s
disease

14. Histological features
• Full thickness dysplasia of epidermis with no
evidence of invasive SCC

15. Treatment options
• Many options, none right or wrong
• Depends on many doctor, patient factors eg
– Affordability
– Compliance
– Equipment
– Cost
– Etc etc

16. Treatment options
• Excision
• Curettage
• Efudix
• Aldara
• Photodynamic therapy
• Cryotherapy
– And probably a few more

17. Dr Ian Katz
• Southern Sun Pathology
• Sydney, Australia