Bowen's Disease Can Mimic Eczema

Is a pre-cancer masquerading as a common skin disorder? 

DERMATOLOGY What is Bowen's disease? Bowen's disease (BD) is a form of intraepidermal carcinoma, a malignant tumor of keratinocytes that may progress to an invasive squamous cell carcinoma (SCC) in situ. It was first documented in 1912 by an American dermatologist named John T. Bowen.

What causes Bowen's disease?

Causes of BD include solar damage, arsenic, immunosuppression (including AIDS), viral infection (human papillomavirus or HPV) and chronic skin injury and dermatoses. [1]

Is Bowen's disease fatal?

Prognosis for BD is favorable with risk for progression to invasive SCC at 3-5%. One third of these cases may metastasize. There is no national health database tracking nonmelanoma skin cancers. A Minnesota study reported an average annual rate of BD as 14.9 cases per 100,000 whites. It is most commonly reported in sun-exposed sites of whites. BD rarely occurs in patients with darker-pigmented skin; if it does, it usually affects nonexposed sites [2] such as the genitals, scalp, breasts or torso.

What are symptoms of Bowen's disease?

Patients often present an asymptomatic, slowly enlarging, erythematous, well-demarcated scaly patch or plaque. It may occur anywhere on the mucocutaneous surface. A delay in diagnosis of BD often is encountered because the lesion is asymptomatic; early skin changes may be subtle and overlap with clinical features seen in many conditions, such as tinea corporis, nummular eczema, seborrheic keratosis, Paget disease, superficial basal cell carcinoma, actinic keratosis, and psoriasis. BD is confirmed by biopsy. [3]

What does Bowen's disease look like?

An unusual clinicopathologic variant is described which presents as a well-circumscribed, papillated, exophytic and endophytic, sometimes keratotic lesion. This papillated variant of BD exhibits keratinocytes with prominent perinuclear halos suggestive of koilocytic change associated with human papillomavirus (HPV) infections. Classic BD has been associated in previous studies with a variety of HPV types, especially types 16, 18, and 31. Papillated BD is distinct from other variants, including the verrucous-hyperkeratotic type. Bowenoid papulosis typically appears as grouped violaceous or red-brown papules in the genital or perianal regions and clinically resembles condylomata acuminata. [4]

What are treatments for Bowen's disease?

Therapy may include topical creams [5], x-ray or grenz-ray radiation, photodynamic therapy (PDT), simple excision, or mohs micrographic surgery, curettage and electrodesiccation, cryotherapy, or laser ablation. [3] The outward appearance of Bowen's disease has considerable variance. Schedule an appointment with a dermatologist for a complete body exam, proper diagnosis, and treatment. (Differential: eczema nummular, erythema multiforme, erythema nodosum, lupus vulgaris, sarcoidosis, tinea corporis)

Tags: bumps, cancerous, clinical research, deadly, dermatopathology, dermatological, dermatology, diagnostic, etiology, oncology, pathology, rash, scars, symptoms

References
  1. Bowen's disease, Wikipedia
  2. Gupta S, Nutan, Dogra S, Kanwar AJ. Bowen Disease over photoprotected site in an Indian male. Dermatol Online J. Oct 15 2009.
  3. Synopsis of 2009 article at eMedicine by Mark P Eid, MD.
  4. Papillated Bowen disease, a distinct variant, Am J Dermatopathol 5:395-8, 2006
  5. Imiquimod 5% cream in the treatment of Bowen's disease, J Am Acad Dermatol, 44:472-70, 2001
  6. Bowen's Disease, DermIS.net