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PubMed2000

Treatment of Bowen's disease of the digit with carbon dioxide laser.

BACKGROUND: Therapy for Bowen's disease is essential to prevent invasive squamous cell carcinoma and metastases. Surgical excision is preferred because of the low relapse rate, but it may result in scar contracture, especially in the digit. OBJECTIVE: This study was undertaken to evaluate the effectiveness of carbon dioxide laser for Bowen's disease of the digit. METHODS: Patients with biopsy-proven Bowen's disease of the digits were recruited from the Department of Dermatology, Siriraj Hospital during the period 1992-1998. Risk factors were assessed. The lesion and 4 mm of surrounding clinically uninvolved skin were vaporized by means of the carbon dioxide laser. Wounds were managed by second intention. Patients were followed up at 1 week, 4 weeks, 6 months, and yearly thereafter if applicable. RESULTS: During this 7-year period, only 6 patients with Bowen's disease of the digits were identified. Four of the 6 had a long history of exposure to arsenic from herbal medicines. Postoperative clinical appearance was mild atrophic skin and hypopigmentation. No functional impairment was found. Biopsy specimens taken after treatment showed a slightly thinned epidermis and mild fibrosis in the papillary dermis. There has been no evidence of recurrence in the 6 months to 7.7 years since surgery. CONCLUSION: At least 67% of the patients affected by Bowen's disease of the digits had chronic arsenicism. It may be the earliest presentation of chronic arsenicism. Carbon dioxide laser provides ease of surgery, excellent cosmesis, preservation of function, and effective treatment for patients with Bowen's disease of the digits.

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PubMedDate not supplied

Bowen's disease: report of a case in a Nigerian man.

Bowen's disease (cutaneous squamous cell carcinoma in situ), like other cancers of the skin, is rare in black people--to our knowledge, only about 43 cases have been published in the medical literature. We report a 59-year old Nigerian man who presented with a five-year history of a mildly pruritic, slowly enlarging well-circumscribed plaque on the lower part of the anterior region of the chest on the right side. The lesion had an irregular crusted periphery and an atrophic hypopigmented centre. Histological examination confirmed a diagnosis of Bowen's disease. No predisposing factor was found to be relevant in this case--although he might have had brief occupational exposure to arsenic, it is unlikely that this was the cause of his disease. The published literature on Bowen's disease in blacks is briefly reviewed.

Black People↗

PubMed2005

Porocarcinoma in a patient with chronic arsenism and multiple Bowen's disease: case report.

BACKGROUND: Chronic arsenism with Bowen's disease is often seen in patients who drink water containing a high level of arsenic. Inorganic arsenic has demonstrated an increased risk of skin cancer. OBJECTIVE: We present a rare case of porocarcinoma in a patient with chronic arsenism and multiple Bowen's disease. METHODS: Report of a case and review of the literature. RESULTS: A case of porocarcinoma arising in a patient with chronic arsenism is presented. The tumor was completely excised by means of wide excision with a 5 mm free margin. The surgical defect was reconstructed with a rhombic flap. CONCLUSION: Chronic arsenism can induce various skin neoplasms, possibly including porocarcinoma.

Arsenic Poisoning↗

PubMed1990

Multiple primary cancers in a case of chronic arsenic poisoning--an autopsy report.

This is an autopsy report of multiple primary cancers observed in a patient who had clinically been diagnosed as chronic arsenic poisoning. An 88-year-old man, non-smoker, had worked in an arsenic mine for 6 years from the age of 47. He had undergone operations for Bowen's disease and gastric cancer at ages 80 and 86, respectively. At autopsy, squamous cell carcinoma of the lung and a polypoid lesion in the piriform recess were found. Furthermore, microscopic examination revealed latent prostatic adenocarcinoma and oncocytoma in the kidney. The polypoid lesion of the piriform recess appeared to originate from the duct of the minor salivary gland in the pharynx, showing an adenoid cystic carcinoma-like pattern with squamous cell carcinoma in part. The cause of death was thought to be respiratory failure due to bronchopneumonia and pulmonary edema as well as hydrothorax, and chronic heart failure following ischemic heart disease. Bowen's disease was followed by four internal malignant tumors, even though the etiological relation between these cancers and arsenic is not clear.

Adenocarcinoma↗

PubMed1982

[Bowen's disease of the nipple].

The clinical and morphological features of Bowen's disease of the nipple are reported. The 51 year old patient had an eczema type change of the left nipple for over 1 year. The microscopic evaluation of the extensive segmental resection showed Bowen's disease of the nipple. Paget's disease was excluded with certainty. As far as the authors know this is the first case of Bowen's disease of the nipple reported. The treatment of choice is extended segmental resection. With this treatment the prognosis of Bowen's disease of the nipple appears to be favourable.

Bowen's Disease↗

PubMed1996

Bowen's disease of the distal digit. Outcome of treatment with carbon dioxide laser vaporization.

BACKGROUND: Bowen's disease (squamous cell carcinoma in situ) is an intraepithelial neoplasm that can transform into invasive squamous cell carcinoma. The preferred method of eradication for Bowen's disease is surgical excision. However, when Bowen's disease occurs on the digit, surgical removal can lead to scar contracture and loss of use of the finger. OBJECTIVE: To assess the utility of carbon dioxide (CO2) laser vaporization in eradicating Bowen's disease of the finger while maintaining the full range of motion and use of the digit. METHODS: Five patients were treated with CO2 laser vaporization for Bowen's disease of the digit. Patients were followed postoperatively for recurrence, clinical appearance, especially for scar formation, and function of the involved joints over a 6-month to 3-year period. RESULTS: Four of five patients had no recurrence. Healing resulted in only modest alterations in the cosmetic appearance in comparison with the surrounding untreated skin. Posttreatment biopsy showed slight thinning of the epidermis and mild fibroplagia limited to the papillary dermis. Patients reported only mild post-procedure discomfort and no patients had any loss of function of the digit. CONCLUSIONS: CO2 laser vaporization may be a safe and effective means by which to eradicate Bowen's disease of the finger without the risk of scar contracture and loss of function of the digit.

Adult↗

PubMed2006

Invasive squamous cell carcinoma arising in refractory perianal Bowen's disease in a HIV-positive individual.

A 54-year-old HIV-positive homosexual man presented with erythematous and pigmented plaques on background erythema in the perianal region, histologically consistent with Bowen's disease. Perianal Bowen's disease represents high-grade anal intraepithelial neoplasia, which is considered a precursor lesion of invasive anal squamous cell carcinoma. This patient's anal intraepithelial neoplasia was unresponsive to multiple treatment modalities including cryotherapy, serial curettage and cautery, topical 5-fluorouracil and 5-aminolaevulinic acid photodynamic therapy. He progressed to develop a poorly differentiated squamous cell carcinoma of the anus three and a half years after the Bowen's disease was diagnosed. The squamous cell carcinoma was treated with combined chemoradiation. A recurrence of high-grade anal intraepithelial neoplasia was noted 6 months after completion of chemoradiation.

Anal Canal↗

PubMed2002

Bowen's disease of the nail.

We present a case of Bowen's disease of the nail bed in a 60-year-old male. This case should remind us to biopsy any chronic lesion of the nail in order to reduce the delay in diagnosis. Indeed Bowen's disease of the nail unit often presents as a clinically misleading 'benign' lesion. Early diagnosis is important as this precancerous lesion appears to have a more aggressive behavior when it affects the nail unit. Bowen's disease of the nail is therefore considered as a squamous cell carcinoma, and both entities are grouped under the term 'epidermoid carcinoma'. Surgical excision is the first treatment option for those tumors without bone involvement. Our patient was treated with Mohs' micrographic surgery which is considered the ideal surgical treatment as it ensures a complete eradication of the tumor in over 90% of the cases but also maximally preserves normal tissue and function. This case illustrates the challenge of Mohs' surgery on the nail unit due to its particular anatomy and histology.

Bowen's Disease↗

PubMed1997

5-fluorouracil iontophoretic therapy for Bowen's disease.

BACKGROUND: Topical 5-fluorouracil (5-FU) is an accepted therapy for Bowen's disease. Recurrences with this method have been attributed to deep follicular involvement and poor patient compliance because of the prolonged treatment time required. OBJECTIVE: We sought to determine whether iontophoresis of 5-FU is an effective therapy for Bowen's disease. METHODS: Twenty-six patients with biopsy-proven Bowen's disease received eight 5-FU iontophoretic treatments in 4 weeks. Local excision was done 3 months after the last treatment. The specimens were step-sectioned and evaluated for any histologic evidence of bowenoid changes. RESULTS: Only 1 of 26 patients showed histologic evidence of Bowen's disease 3 months after treatment. CONCLUSION: 5-FU iontophoresis appears to be a safe, effective, and well-tolerated therapy for Bowen's disease.

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PubMed1990

Human papillomavirus infection and filaggrin expression in paraffin-embedded biopsy specimens of extragenital Bowen's disease and genital bowenoid papulosis.

Cutaneous Bowen's disease (BD) and genital bowenoid papulosis (BP) are considered as precancerous or cancerous lesions that are sometimes infected with human papillomavirus (HPV). We studied retrospectively paraffin-embedded sections of 11 samples of cutaneous BD and 6 samples of genital BP from the general population for HPV infection and filaggrin expression. Using in situ hybridization with biotinylated probes of HPV types 1, 2, 5, 6, 11, 16, and 18, under stringent and/or non-stringent conditions and a streptavidin-alkaline-phosphatase complex for hybrid detection, HPV DNA was detected in 6/17 cases (5 BD and 1 BP). Positive nuclei were located in intermediate or upper epithelial cell layers. HPV 16 was found in 2 cases of BD but associated either with HPV 2 or 18. Three additional lesions reacted only under non-stringent conditions; HPV could not be typed with the probes used. The positive case of BP reacted with the four probe types 1, 2, 16, 18 and was negative with HPV 6 or 11. Viral antigen was not detected by indirect immunofluorescence with a rabbit antiserum directed to group-specific viral capsid antigen. Differentiation disorders were observed in the intermediate and upper cell layers of these specimens, as shown by a reduced expression of filaggrin/profilaggrin, a marker of terminal differentiation, in extragenital BD (7/11 cases), and an increased expression in genital BP (4/5 cases) although viral DNA was not always detectable. This study shows that in situ hybridization is a valuable technique for HPV DNA detection and its typing in BD and BP lesions on deparaffinized sections. The positive nuclei were located in the cell layers that exhibited abnormal expression of differentiation. There is no relation between the HPV infecting type and the filaggrin expression.

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PubMed1989

Bowen's disease and internal malignancy. A meta-analysis.

Bowen's disease frequently has been reported to be associated with internal malignancy, although this association has been extremely controversial. The present study uses the technique of meta-analysis to address this issue by pooling the results of the 12 studies published in the English-language literature that previously have attempted to study this issue. The results indicated no significant association between the two conditions (chi square, 1 d.f., = 0.128, p greater than 0.05, 95% confidence interval = 0.105-0.1503). Clearly, no extensive investigation in patients having Bowen's disease is warranted.

Bowen's Disease↗

PubMed1998

Treatment of cutaneous Bowen's disease with particular emphasis on the problem of lower leg lesions.

Bowen's disease has a particular predilection for the lower leg, especially in women. A review of the literature for treating Bowen's disease is presented and the problems associated with treating the lower leg emphasized. Evidence for the various treatment modalities used to treat Bowen's disease largely comes from studies that lack good methodology in terms of standardized techniques, patient controls and adequate follow-up. In particular the widely accepted recommendation for excision is not supported by evidence that this treatment is superior to other modalities. The choice of treatment for Bowen's disease should take into account the patient's general condition, the site and size of the lesion.

Bowen's Disease↗

PubMed2002

A case of multiple Bowen's disease with squamous cell carcinoma of the larynx and adenocarcionoma of the prostate.

Bowen's disease, or cutaneous squamous cell carcinoma in situ, has been regarded as a cutaneous marker for internal malignancy. However, the relationship of Bowen's disease to visceral cancers remains controversial. We present a 76-year-old male with multiple lesions of Bowen's disease, who later developed laryngeal cancer and subsequent prostate cancer with distant metastases. Efforts to detect possible common etiologic agents including human papillomavirus and chronic arsenicism revealed no association between Bowen's disease and the internal malignancies. Despite the controversy, we suggest that a conservative cancer workup is ethically indicated in patients with multiple Bowen's disease.

Adenocarcinoma↗

PubMed1996

Bowen's disease and arsenism from tobacco smoke: an association?

Bowen's disease has long has been associated with arsenic ingestion. Due mostly to arsenic-containing insecticides, the arsenic content of American tobacco was quite high until the early 1960s. A chart review of sixteen patients seen with Bowen's disease in the past five years showed that eleven (including five women) had been smokers in the 1950s. While these data may be insignificant, this possible association deserves further analysis. Arsenism from tobacco might explain the discordant results of the studies on the carcinogenicity of psoralen/ultraviolet A.

Arsenic↗

PubMed2006

Management of less common tumors of the colon, rectum, and anus.

The majority of colorectal and anal malignancies are adenocarcinomas and squamous cell cancers, respectively. Despite the predominance of these neoplasms in these locations, rare histiotypes of the colon, rectum, and anus do occur. These histotypes include but are not limited to lymphoma, melanoma, diffuse cavernous hemangioma, and sarcomas, such as leiomyosarcoma or Kaposi's sarcoma. These tumors often present challenges to clinicians with respect to diagnosis, staging, management, and pathology because of their unfamiliarity. A Medline search using "colon," "rectum,""anus," "lymphoma," "melanoma," "diffuse cavernous hemangioma," "squamous cell carcinoma," "carcinoid," "sarcoma," "leiomyosarcoma," "Kaposi's sarcoma," "Paget's disease," "Bowen's disease," and "basal cell carcinoma" as key words was performed as well as a cross-referencing of the bibliography cited in each work. Rare tumors of the colon, rectum, and anus present diagnostic and management dilemmas for clinicians. Because of their infrequency and poor prognosis, the optimal management of these tumors is controversial. For some histotypes, such as squamous cell carcinoma and carcinoids of the rectum, treatment depends on location and size of the tumor. For uncommon anal lesions, such as Bowen's disease, Paget's disease, and basal cell carcinoma, wide local excision (WLE) with negative margins is the standard of care. For other lesions such as anorectal melanoma or leiomyosarcoma, abdominal perineal resection versus WLE is still being debated. Because the optimal treatment of these tumors is still unclear, we recommend a multidisciplinary approach including a surgeon, primary care physician, medical oncologist, radiation oncologist, and pathologist to offer the patient the best outcome.

Carcinoma, Squamous Cell↗

PubMed1979

Bowen's disease and 5-fluorouracil.

Sixty-six confirmed cases of Bowen's disease (intraepidermal squamous cell carcinoma) were seen from 1965 through 1976: twenty-four cases were treated surgically-four by excision (two recurrences) and twenty by desiccation and curettage (four recurrences); one was treated with x-ray radiation; and forty-one were treated with topical 5-fluorouracil (5-FU) (three recurrences). Of the six surgical recurrences (25% recurrence), one was retreated by desiccation and curettage and five with 5-FU. Of the three recurrences after 5-FU (8% recurrence), all three were successfully retreated with 5-FU. In view of the generally high recurrence rate after all treatment modalities in Bowen's disease, related to both the ill-defined lateral margins and the frequent follicular involvement with the Bowen's process, prolonged treatment time is required for success with 5-FU. Treatment times employed were 4 to 12 weeks, with a median of 9 weeks. 5-FU concentration ranged from 1% to 3 % in propylene glycol. A 1% concentration of 5-FU was generally adequate on the face, except for occasional recalcitrant areas, such as the nose and eyebrow. A concentration of 2.5% to 3.0% was usually necessary for treatment of Bowen's disease on the other body areas.

Administration, Topical↗

PubMed1992

Cutaneous Bowen's disease. An analysis of 1001 cases according to age, sex, and site.

BACKGROUND: There are no large studies of Bowen's disease that have analyzed its distribution according to age, sex, and site. OBJECTIVE: This study was performed primarily to determine whether there were significant sex and site differences in the distribution of Bowen's disease. METHODS: One thousand one skin biopsy specimens of Bowen's disease were analyzed according to age, sex, and site of origin. RESULTS: This study revealed that the most common site of Bowen's disease was the head and neck (440 lesions), whereas specimens from the lower limbs (298 lesions) and upper limbs (198 lesions) outnumbered specimens from the torso (65 lesions). Of 298 specimens from the lower limbs, 72.1% were from women; 79.3% of the 87 specimens from the scalp and ears were from men. Eighty percent of the 85 specimens of Bowen's disease from the cheeks were from women. CONCLUSION: These results indicate that cutaneous Bowen's disease occurs mainly on sun-exposed sites. This is also supported by the predominance of Bowen's disease on the lower limbs in women and on the scalp and ears in men. The basis for the female predominance on the cheeks is unknown, but may reflect the increased vulnerability to sun damage of superficial vellus hair follicles that predominate on the cheeks in women. This finding may provide indirect support for the hypothesis that some forms of Bowen's disease have a follicular histogenesis.

Adult↗

PubMed2001

Human papillomavirus type 58 in Bowen's disease of the elbow.

Human papillomavirus (HPV) can be detected in skin lesions of Bowen's disease, particularly on the fingers, and its genotype is associated with mucosal/genital types of HPV. We report herein an 85-year-old woman who had HPV-associated Bowen's disease on her elbow. HPV-58 DNA was detected in the lesion by polymerase chain reaction with restriction fragment length polymorphism and by Southern blot hybridization. In situ hybridization revealed numerous hybrid cells in the nuclei of the upper epidermis and stratum corneum of Bowen's disease. A high-risk type of mucosal HPV-58 DNA is associated with Bowen's disease in this case, suggesting that HPV-related Bowen's disease is not always restricted to genital or finger lesions.

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