Bowen's disease

Bowen, 1912

M.Bowen, Mb. Bowen, Dyskeratosis maligna, carcinoma in situ, Bowen`s disease, Carcinoma in situ type Bowen`s disease.

Carcinoma in situ, which originates from the keratinocytes. In the area of the genital mucosa, this is called erythroplasia.

• Increased risk with age
• Mostly in patients with fair skin type

Trigger

• Cumulative UV radiation
• Arsenic
• Human papillomavirus

• Mostly solitary, rather sharply demarcated, erythematous, centrifugally expanding, eczematoid, scaly plaque
• In 40% the skin change is solitary, in 60% multicentric
• Eerosive, leukoplakia-like Bowen's disease may occur in the mucosal region

Transition to spinocellular carcinoma in up to 50% of cases

Therapy of choice:

• Excision with histological marginal control

Alternatively

• Curettage
• X-ray soft beam technique (3-5 Gray, GD: max. 60 Gray, GHWT 1.0 mm)
• Cryosurgery
• Laser
• Photodynamic therapy

• 5-Fluorouracil ointment 5%
  • 1-2 x daily occlusive: only on skin lesions, not on healthy skin! Basaliomas should be treated until ulceration, other lesions until erosion!

• Imiquimod cream: 5x weekly for 6 weeks

1. Majores M, Bierhoff E. Aktinische Keratose, Morbus Bowen, Keratoakanthom und Plattenepithelkarzinom der Haut. Pathologe 2015;36:16-29.
2. Majores M, Bierhoff E. [Actinic keratosis, Bowen's disease, keratoacanthoma and squamous cell carcinoma of the skin]. Pathologe 2015;36:16-29.
3. Thestrup-Pedersen K, Ravnborg L, Reymann F. Morbus Bowen. A description of the disease in 617 patients. Acta Derm Venereol 1988;68:236-9.
4. Grussendorf EI, Bar T. Condylomata acuminata associated with morbus Bowen (Carcinoma in situ). A light and electron microscopic study. Dermatologica 1977;155:50-8.
5. Seyss R, Kopf O. [Roentgenotherapy of morbus Bowen and multiple carcinoids]. Krebsarzt 1952;7:15-8.