1. Bowen's disease is a rare pre-cancerous skin condition that affects the outer layer of the skin. It appears as a slow-growing reddish patch or plaque. Risk factors include chronic sun exposure and immunosuppression. 2. Diagnosis involves biopsy of affected tissue. Treatment options depend on the location and size of lesions, and include topical chemotherapy or immunotherapy creams, curettage and electrocautery, cryotherapy, and observation. 3. The best prevention is limiting sun exposure and using sun protection, as overexposure is a major risk factor for Bowen's disease.

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Ministry of Education Republic of Belarus
Vitebsk Order of Peoples’ Friendship State Medical University
Department of Maxillofacial Surgery & Dentistry
Head of the Department: Associate Professor A.A. Kabanova
Teacher: A.K. Pagotski
Referath
Topic: Bowen’s Disease. Etiology. Pathogenesis. Clinic.
Diagnosis. Treatment. Prevention of complications.
Prevention.
DinooshDe Livera
Student3rd Course
Group No: 50
InternationalStudents’ TrainingFaculty
VSMU
2015’

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Background
Bowen disease is a rare skin disorder. Bowen disease was first described in the medical literature
by a physician named JT Bowen in 1912. Bowen disease is also known as squamous cell
carcinoma in situ, and is generally considered an early, noninvasive form of intraepidermal
squamous cell carcinoma. Intraepidermal means that the disease occurs inside the epidermal
layer of the skin.
Affected individuals develop a slow-growing, reddish scaly patch or plaque on the skin. Sun
exposed areas of the skin are most often affected. Bowen disease only affects the outermost layer
of the skin (epidermis). Lesions are usually not painful or may not be associated with any
symptoms (asymptomatic). In most cases, treatment is highly successful. Bowen disease is
considered a pre-cancerous condition, although the risk of developing skin cancer is less than 10
percent. The disorder usually affects older adults. The exact cause of Bowen disease is unknown,
although there are identified risk factors such as chronic sun exposure.
Erythroplasia of Queyrat is a particular type of Bowen's disease that can arise on
the glans or prepuce in males, and, on the vulva in females, and may be induced by human
papilloma virus. It is reported to occur in the corneoscleral limbus
Risk Factors:
Too much exposure to the sun over a long period of time is probably the most important risk
factor for Bowen’s disease. But it can occur in areas that have not been exposed to the sun, so
this is not the only cause.
People who have previously had radiotherapy in the affected area are also at risk of developing
Bowen’s disease. Rarely, exposure to a chemical called arsenic can be the cause. People who
have to take drugs that lower their immunity (for example, after a kidney transplant) are more at
risk of getting Bowen’s disease.
Occasionally, Bowen’s disease can affect the genital area. This is usually linked with a common
type of virus called human papilloma virus (HPV). HPV may also be linked with Bowen’s
disease on the hands and feet. There are different types of this virus. Some are linked with other
cancers, such as cervical cancer.

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Related Disorders
Symptoms of the following disorders can be similar to those of Bowen disease. Comparisons
may be useful for a differential diagnosis.
There are numerous different skin disorders that can resemble Bowen disease and the disorder is
often mistaken for psoriasis or eczema. Additional skin disorders that can resemble Bowen
disease include superficial basal cell carcinoma, actinic keratosis, seborrheic keratosis, lichen
planus, tinea corporis and extramammary Paget’s disease. (For more information on these
disorders, choose the specific disorder name as your search term in the Rare Disease Database.)
When Bowen disease affects the genitals, it may be known as erythroplasia of Queyrat
(involving the mucosal inner surface of the glans) in men or as a type of vulval intraepithelial
neoplasia in women. Some researchers considered these conditions separate entities that are
related to, but distinct from, Bowen disease.
Erythroplasia of Queyrat is also known as Bowen disease of the glans penis, although the latter
term actually refers to the condition on the outer keratinized surface of the penis. The glans penis
is the sensitive tip of the penis. Affected individuals develop a reddish, velvety or smooth plaque.
A wide variety of symptoms can occur including crusting, scaling, ulceration, pain or itching.
Bleeding, difficulty or pain when urinating (dysuria), or discharge may also occur. Erythroplasia
of Queyrat occurs most often in middle aged men who are not circumscribed. The exact,
underlying cause is of this disorder is unknown.
Vulvar intraepithelial neoplasia (VIN) is a general term for a skin condition that affects the vulva
of women. Lesions may be bright red and have a velvety appearance. Initially there may be no
associated symptoms, but eventually itching or burning sensations may develop. Itching can
potentially be severe. The exact cause of VIN is unknown, by many cases are strongly associated
with human papillomavirus 16.
Affected Populations (Epidemiology)
The exact incidence of Bowen disease in the general population is unknown. Bowen disease is
most frequently diagnosed in Caucasian individuals over the age of 60, although can occur in
individuals much younger. It is believed to occur more frequently in males than females.

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Etiology
The exact cause of Bowen disease is unknown. Chronic sun exposure and aging are believed to
be two major risk factors for developing the disorder. Individuals with fair skin and individuals
who spend a lot of time outdoors in the sun are at a greater risk of developing Bowen disease.
Individuals who take drugs to suppress the immune system (usually taken to treat an immune
system disorder) are also at a greater risk than the general population of developing Bowen
disease.
Individuals who have cutaneous human papillomavirus (HPV) infection are at risk of developing
Bowen disease. Human papilloma viruses are a group of more than 150 related viruses, some of
which can cause cancer. HPV 16, 18, 34, and 48 have caused Bowen disease at genital sites.
HPV 16 is most commonly associated with the development of Bowen disease. HPV 16 is also
the cause of some cases of cervical cancer. Less often, HPV types 2, 16, 34, and 35 are
associated with Bowen disease in areas of the body other than the genitals.
Chronic exposure to arsenic appears to be a risk factor for the development of Bowen disease as
well. Arsenic is a tasteless, colorless metal element. Arsenic has many uses in manufacturing and
other commercial uses. According to the medical literature, chronic exposure to arsenic can
cause Bowen disease, approximately 10 years or so after initial exposure. In the past, arsenic was
known to have contaminated well water and was once used in various medical preparations.
Arsenic exposure occurs far less often today than it did in the past.
Clinic
Bowen’s disease can occur anywhere on the body. But it is usually found on areas that are
exposed to the sun. These include the face, neck or lower legs. To begin with, Bowen’s disease
often looks like a red, scaly patch. Sometimes it can look like raised spots or warts. The affected
skin may become itchy or sore and may bleed. Bowen’s disease can look like other skin
conditions, such as eczema or psoriasis. So it is important to get any skin problems checked by a
doctor.
Typically, Bowen disease appears as a slow-growing, persistent reddish-brown patch or plaque
of dry, scaly skin. These lesions may be flat or slightly raised. The lesions are normally not
associated with any symptoms, but, occasionally, can itch, ooze pus, bleed or become crusted
and/or tender. In some cases, the lesions may be warty (verrucous), split open (fissured) or, less
often, darkly colored (pigmented). In most cases, there is only one lesion, but in approximately
10-20 percent of individuals multiple lesions may develop usually in more than one area of the
body.

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Although Bowen disease occurs most often on sun exposed areas of the skin, it can develop
anywhere on the body, even areas of the skin that are not usually exposed to the sun. The
disorder most often develops on the lower legs. Less commonly, the head, neck, palms, soles and
genitals can be affected. The lesions can measure anywhere from a few millimeters to a few
centimeters.
Individuals with Bowen disease are at risk of developing skin cancer. The risk is estimated to be
less than 10 percent, but can be higher in individuals with a compromised immune system. Early
signs of cancerous transformation in Bowen disease include the development of a fleshy nodule
or bump in a skin lesion. This nodule may be tender and bleed easily. Ulceration or hardening
(induration) of a skin lesion also indicates malignant transformation.
Bowen disease is classified as an early, noninvasive form of squamous cell carcinoma, a type of
skin cancer that most often occurs on sun damage areas of the skin. Squamous cell carcinoma is
the second most common form of skin cancer.
Diagnosis
A diagnosis of Bowen disease is suspected based upon identification of characteristic symptoms,
a detailed patient history and a thorough clinical evaluation. The disorder is easily mistaken for
other skin disorders such as eczema or psoriasis and can be overlooked because there may be no
associated symptoms. Bowen disease may sometimes first be noticed during a routine skin
examination.
Clinical Testing and Work-Up: A diagnosis of Bowen disease may be confirmed by a biopsy of
affected tissue. With a biopsy, a sample of affected tissue is removed and studied under a
microscope. A biopsy can help to differentiate Bowen disease from other skin disorders with a
similar appearance. The sample taken must be deep enough to rule out invasive squamous cell
carcinoma.
Treatment
There is no specific, definitive treatment for Bowen disease. Several different therapies may be
used all of which have excellent success rates.
The specific treatment for an individual case depends upon numerous factors, such as the site of
the body affected; the size, thickness and number of the lesion(s); the presence or absence of
certain symptoms; an individual’s age and general health; and/or additional elements.
There are many different treatments for Bowen’s disease. The treatment you have will depend
on:

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 where the area of Bowen’s disease is on your body
 its size and thickness
 the number of affected areas you have.
An important factor when deciding which treatment you will have, is how well the skin is likely
to heal afterwards. For example, skin on the lower legs tends to be more fragile, especially in
older people. This means it may not heal as well, so some treatments may not be suitable.
Chemotherapy cream
A chemotherapy cream called 5-fluorouracil (Efudix®) may be used. It is also called 5FU.
Chemotherapy is the use of anti-cancer drugs.
You put the cream onto the skin regularly over a period of time. Your nurse or doctor will tell
you how often. It can make the skin in the area red and inflamed before the Bowen’s disease gets
better. Usually there are no other side effects.
Immunotherapy cream
A cream called imiquimod (Aldara®) can be used. It is a type of immunotherapy. This means that
it works by using the immune system to attack the abnormal cells. You put it on the skin
regularly over a period of time. It will cause some redness and skin irritation before the Bowen’s
disease improves.
Curettage and electrocautery
This is when the doctor scrapes away the affected area (curettage). Then they use heat or
electricity to stop any bleeding (electrocautery).
First the doctor will give you a local anaesthetic to numb the area. Then they scrape away the
area using a spoon-shaped instrument called a curette. They use an electrically-heated loop or
needle to stop the bleeding from the wound and destroy any remaining abnormal cells. After this
treatment, a scar may develop.
This treatment may be suitable for small patches of Bowen’s disease.
Photodynamic therapy (PDT)
Photodynamic therapy is a treatment that is used for different conditions. It can be a useful
option if you have large areas of Bowen’s disease. It uses light combined with a light-sensitive
drug to destroy abnormal cells.
The doctor or nurse puts light-sensitive cream on the affected area. About three to four hours
later, they shine a special light onto the area for about 10 to 15 minutes. The light destroys cells
that have absorbed the cream.

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Some people may find they get a stinging or burning feeling in the treatment area. Tell your
doctor or nurse if you are uncomfortable. They can give you something to help.
Afterwards, the doctor or nurse will put on a dressing to cover the area and protect it from light.
You may need more than one treatment. Your doctor will tell you how many you may need.
Surgery
Doctors may use surgery for small areas of Bowen’s disease that can be removed under local
anaesthetic. This is not always the best option for large patches of Bowen’s disease.
Cryotherapy
It may be possible to treat the area by freezing it. This is called cryotherapy or cryosurgery. The
dermatologist will carefully spray liquid nitrogen onto the area to freeze the cells. It will feel
very cold and a bit uncomfortable for a short time. Afterwards, you will have a scab, which
usually falls off within a few days or weeks. This removes the affected skin. How quickly it
heals depends on where it is. If the area is on your face, it may heal within two to three weeks.
But other areas can take a bit longer.
Observation
Bowen’s disease often grows very slowly, over a period of months or years. You may have a thin
patch of affected skin that is not changing. In this case, your dermatologist may advise you to
just keep checking it for changes. You may also have regular check-ups to monitor it carefully.
Observation can be a good option if you are more likely to have problems with skin healing after
treatment. Tell your dermatologist if you notice any changes or develop an ulcer (sore) on the
patch of Bowen’s disease.
Laser treatment
Laser treatment uses intense light energy to remove tissue. It is sometimes used as a treatment
for Bowen's disease that affects the fingers or genitals. Doctors are carrying out research trials to
find out how effective this treatment is in the long term.
Radiotherapy
Radiotherapy uses high energy x-rays to treat abnormal cells. It is sometimes used if you have
Bowen’s disease that is causing symptoms, such as pain or bleeding. Doctors may also use it on
areas that come back after treatment. It is not usually used on areas where the skin takes longer
to heal, such as the lower legs.

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Prevention
The most important step to take to lower the risk of Bowen disease is to limit or avoid excess
exposure to the sun. Protective clothing, sunscreen, avoiding tanning beds and other measures
can be taken to lower the risk of developing Bowen disease.
Investigational Therapies
Various case reports in the medical literature discuss the use of laser therapy for the treatment of
Bowen disease. In individual patients, laser therapy has been effective in treating the disorder.
However, no clinical trials in large populations have been undertaken. In addition, laser therapy
may be expensive and have limited availability. More research is necessary to determine the
long-term safety, effectiveness and viability of laser therapy as a potential treatment for Bowen
disease.
Protecting yourself from the sun is even more important when you have had Bowen’s disease.
Here are some tips for staying safe in the sun:
 Wear clothing made of cotton or natural fibres that have a close weave. These will give you more
protection against the sun.
 Keep your arms and legs covered by wearing long-sleeved tops and trousers.
 Protect your face and neck with a wide-brimmed hat.
 Always wear sunglasses in strong sunlight. Look for glasses with the CE mark.
 Use suncream with a high sun protection factor (SPF) of at least 30, and 4 or 5 stars. Follow the
instructions on the bottle and re-apply as recommended, particularly after swimming. Remember
to apply suncream on and behind your ears.
 Do not let your skin burn.
 Stay out of the sun during the hottest part of the day. This is usually between 11am and 3pm.