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PubMed1992

Mutant p53 protein is expressed in Bowen's disease.

A total of 26 specimens of histologically determined, cutaneous Bowen's disease from 23 patients were investigated for the incidence of mutant p53 protein expression by an indirect immunoperoxidase technique using the monoclonal antiserum CM1 on paraffin-embedded formalin-fixed tissue sections. Its potential role as a label of cutaneous malignancy was also evaluated: 15 specimens (57.7%) showed nuclear positivity of dysplastic keratinocytes, whereas 11 specimens (42.3%) were immunonegative. Cytoplasmic labeling was never a feature. In general, labeling was predominantly diffuse in distribution although in a significant proportion it was focal. One of two concurrent basal cell carcinomas arising adjacent to plaques of Bowen's disease was immunopositive. Focal immunopositivity of "cytologically normal" adjacent epithelium was seen in six specimens (23%). The study confirms the presence of mutant p53 protein in the majority of nongenital Bowen's disease. Its identification within nuclei of the adjacent "normal" epidermis may represent a potential marker of early (visible) neoplastic transformation.

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PubMedDate not supplied

[Perianal Bowen's disease: a case report and review of the literature].

Perianal Bowen's disease is a uncommon, slow growing, intraepidermal squamous-cell carcinoma (carcinoma in situ) of the anal region and may be a precursor to squamous carcinoma of the anus. It is associated with cervical and vulvar intraepithelial neoplasia and have human papillomavirus as a common cause. Both sexes and all races are affected, with the highest prevalence in patients aged 20 to 45 years. The symptoms of anal Bowen's disease are unspecific and the clinical findings are uncharacteristic and include pain, itching, bleeding and a disturbing lump. Biopsy and histopathologic examination is required for diagnosis and to distinguish other perianal dermatoses; thus an anogenital warts that fail to respond to conventional therapy, or change in appearance, warrant a biopsy and, where the technique is available, DNA typing to identify the viral pathogen. Infact the etiologic agent, the human papillomavirus (HPV), has been classified by DNA techniques into at least 42 types, of which 16 and 18 are considered to carry a high risk for cancer. The intraoperative findings is a lesion at the anocutaneous line: perianal or intra-anal tumor, erosion or ulceration as well as lichenoid lesion or hyperpigmentation. The disease has a proclivity for recurrence and there are many controversies concerning treatment that effectiveness remains uncertain and range from aggressive wide local excision with skin grafting when necessary to laser vaporization (argon or CO2), radiotherapy or a new immune response modifier (Imiquimod). We report a case of a 50-years-old woman with recurrence of Bowen's disease associated with vulvar HPV infection and review the literature.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1995

Detection of human papillomavirus in extragenital Bowen's disease using in situ hybridization and polymerase chain reaction.

Extragenital Bowen's disease (EBD) has rarely been studied for the presence of human papillomaviruses (HPVs). Twenty consecutive patients with EBD were investigated for the presence of HPVs using in situ hybridization with a generic probe that can detect HPV DNA types 6, 11, 16, 18, 30, 31, 33, 35, 45, 51, and 52 and specific probes for HPV DNA types 6/11, 16/18, and 31/33/35. All cases were tested with the polymerase chain reaction (PCR) technique employing the L1 consensus primer pair, MY11 (primer for the positive strand) and MY9 (primer for the negative strand) complementary to genital and dermal HPV types. Seven caucasian patients, five males and two females, with an average age of 70.4 years, showed positive in situ hybridization (ISH) for HPV DNA. The positivity varied from 5 to 40% of neoplastic cells. Three of seven of the ISH DNA-positive cases showed a positive PCR for DNA HPVs. The role of HPVs in human tumors is not fully understood since oncogenic types of HPVs have been found in normal tissue and the actions of cofactors have been postulated. Bowen's disease usually occurs in elderly people in whom the efficiency of the immune systems may be compromised. The association between HPV infection and low efficiency of the immune response may be responsible for HPV-related Bowen's disease in elderly people.

Adult↗

PubMed2003

Treatment of Bowen's disease using a cycle regimen of imiquimod 5% cream.

Bowen's disease (BD; intraepithelial squamous cell carcinoma) is a challenging condition to treat because lesions, which can be multiple, are often located at sites that heal poorly, such as the shin. The disease is usually persistent and progressive and appears as an enlarging, demarcated erythematous plaque. Two elderly female patients with Bowen's disease of the lower leg are presented. Imiquimod 5% cream was applied in a cycle of three times weekly for 3 weeks followed by a 4-week rest period. The treatment was successful after a second cycle of therapy, with both cases clinically clear at 2- and 3-month follow-up visits.

Adjuvants, Immunologic↗

PubMed2000

Hyperthermic treatment of Bowen's disease with disposable chemical pocket warmers: a report of 8 cases.

Bowen's disease is a form of squamous cell carcinoma in situ, in which local hyperthermia may be efficacious. We studied 8 patients with Bowen's disease to ascertain whether hyperthermia can be effective against it. As a heat source, disposable chemical pocket warmers were applied daily with pressure directly to the lesion site while the patient was awake, and the clinical course was observed for 4 to 5 months. The lesion was then excised and examined to determine the histopathologic effects. The results showed efficacy in 6 cases, in which the nodular and invasive lesions and the erythematous patches abated; then the lesions disappeared, leaving deposits of pigment (complete remission). In one case, the signs improved by at least 50% (partial remission); in the other case, there was only slight palliation (no response). As for the posttreatment histopathologic effects, tumor cells were eliminated in 3 cases, isolated tumor cells were seen in 3 cases, and there was no change in 2. Although the treatment did not yield perfect results, it represents a major improvement of hyperthermic therapy and is one effective method of treating Bowen's disease.

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PubMed1987

Polydactylous Bowen's disease of the nail.

We present three patients with Bowen's disease of the fingernail folds and beds in which there was polydactylous involvement and add those to five similarly afflicted patients described by other authors. Bowen's disease of the nail is a distinctive type of squamous cell carcinoma that differs from other variants. It is potentially an autochthonous process that can involve more than one nail with the passage of time. Seven-eighths of the patients described in this series were men. A majority had involvement of both hands. No metastases were seen.

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PubMed2007

Therapeutic options for Bowen's disease.

Multiple therapeutic options are available for treatment of Bowen's disease. The choice of therapy depends on clinical circumstance and medical practitioner experience. Newer therapies have more extensive support from the literature, but more established therapies may be preferred because of accessibility, cost and efficacy. An overview of the current therapeutic options for Bowen's disease is presented.

Aminoquinolines↗

PubMed2004

Management of Bowen's disease of the skin.

Each year around 15 per 100,000 people in the UK develop intra-epidermal squamous cell carcinoma--Bowen's disease. The lesions of Bowen's disease are slow-growing, erythematous scaly skin plaques that cause few, if any, symptoms. However, if left untreated, they progress to invasive squamous cell carcinoma in 3-5% of patients. Here we review the management of Bowen's disease.

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PubMed1990

Enhancement of the clinical margins of Bowen's disease by acetowhitening.

Acetic acid was applied preoperatively to 12 lesions of Bowen's disease to determine if acetowhitening could more clearly define clinical margins. Acetowhitening disclosed the true margins better than unenhanced direct visualization, and subclinical extension of Bowen's disease was revealed by acetowhitening in three lesions. Acetowhitening can be a useful adjunct in the surgical management of Bowen's disease.

Acetates↗

PubMed1997

Large patches of Bowen's disease treated by topical aminolaevulinic acid photodynamic therapy.

Large patches of Bowen's disease (intraepidermal carcinoma in situ) can be difficult to treat by conventional methods. Photodynamic therapy (PDT) uses the combination of a photosensitizer, which preferentially accumulates in malignant cells, and photoactivation by visible light to kill the malignant cells. 5-aminolaevulinic acid (ALA) PDT uses excess exogenous ALA, which produces, via the haem synthesis pathway, a build up of the photosensitizer protoporphyrin IX. We describe the use of topical ALA PDT to treat three patients with three especially large patches of Bowen's disease. Following two treatments all three lesions achieved a complete clinical and histological response with a good cosmetic result. ALA PDT is a simple, effective and well tolerated treatment for large patches of Bowen's disease.

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PubMed1994

Intraepidermal squamous carcinoma (Bowen's disease) of the nipple.

A case of Bowen's disease of the nipple clinically resembling Paget's disease is reported. This lesion was differentiated from other pagetoid lesions by negative histochemical stains for mucin and melanin, positive immunohistochemical preparation for high-molecular weight cytokeratin 66 kd (904) using adequate controls, and electron microscopic findings of squamous cell features. The therapeutic implications of such a pagetoid nipple lesion in the absence of an underlying breast carcinoma are discussed.

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PubMed1982

Bowen's disease at the limbus.

Ten cases of Bowen's disease at the limbus have been clinicopathologically studied and followed up for 1 1/2 to 9 years. The clinical appearance might be classified into 3 principal forms; i.e., papillomatous, leukoplakic and gelatinous forms. However, histopathological differences could not be detected in the respective forms. In the follow-up study no recurrence was observed in the 8 cases treated with excision and cryotherapy, though recurrence and malignant change took place in one case of the remaining 2 cases, treated with excision only.

Adult↗

PubMed1987

Perianal Bowen's disease and associated malignancies. Results of a survey.

In 1959, Graham and Helwig reported that 80 percent of patients with Bowen's disease developed associated cutaneous or internal malignancies. Subsequent to the publication of this report, extensive and invasive workup of patients with Bowen's disease became the standard of practice. The authors' personal experience with perianal Bowen's disease suggested a substantially lower correlation between that disease and associated malignancies. Therefore a survey was initiated by contacting active members of the American Society of Colon and Rectal Surgeons to investigate further. Analysis of 106 cases demonstrated a lower incidence of associated malignancies (4.7 percent) subsequent to diagnosis of perianal Bowen's disease. The data further indicated, however, that these patients are at risk to develop recurrent Bowen's disease (9.4 percent) and invasive carcinoma (5.7 percent). It is concluded that an extensive and invasive workup of patients with perianal Bowen's disease is not indicated and that the patient's greatest risk is development of recurrent or invasive disease.

Adult↗

PubMed2005

Cutaneous squamous carcinoma in situ (Bowen's disease): treatment with Mohs micrographic surgery.

BACKGROUND: Bowen's disease (BD), also known as squamous intraepidermal carcinoma, is a malignant skin tumor with a potential to progress to invasive carcinoma. OBJECTIVE: We sought to report a large series of patients with BD treated with Mohs micrographic surgery (MMS). METHODS: This prospective, multicenter, case series included all patients in Australia treated with MMS for BD, who were monitored by the Skin and Cancer Foundation between 1993 and 2002. RESULTS: There were 270 cases; the majority (93.4%) were located in the head and neck area. In 50.7% of cases it was a recurrent tumor. In 20% the tumor was initially misdiagnosed as basal cell carcinoma or squamous cell carcinoma. No cases with perineural invasion were diagnosed. There were 6 cases of recurrence (6.3%) of 95 patients who completed a 5-year follow-up period after MMS. CONCLUSION: The low 5-year recurrence rate of BD with MMS emphasizes the importance of margin-controlled excision, especially in the head and neck area where tissue preservation is essential.

Adult↗

PubMed1976

Treatment of Bowen's disease with topical dinitrochlorobenzene and 5-fluorouracil.

"Bowen's disease" is a clinical and histologic diagnosis describing the lesions (single or multiple) of cutaneous in situ squamous cell carcinoma. The case of a 54-year-old man with 60 such intra-epidermal carcinomas, and a history of arsenic ingestion, is presented. The patient was sensitized to dinitrochlorobenzene (DNCB), and his lesions were treated with a topical DNCB preparation. All lesions disappeared completely (demonstrated by biopsy of several sites) except for a large (12 X 7 cm) tumor on the flank which partially resolved. Total regression of this lesion was achieved by adding topical 5-fluorouracil (5-FU) therapy. This case demonstrates that the inflammatory reaction induced by DNCB (as evidenced by erythema and by a dense inflammatory cell infiltrate in biopsied areas of treated lesions) can lead to regression of extensive in situ epidermoid carcinoma, and that combined therapy with DNCB and 5-FU can be more effective than DNCB alone. Both agents in appropriate concentrations led to selective destruction of neoplastic tissue with no effect on adjacent normal skin. No systemic toxicity was observed.

Arsenicals↗

PubMed1991

In-vitro DNA synthesis of keratinocytes in normal human skin, psoriasis, seborrhoeic keratosis, Bowen's disease and basal cell carcinoma.

The DNA-synthesizing cells in benign and malignant keratotic diseases including psoriasis, seborrhoeic keratosis, Bowen's disease and basal cell carcinoma were studied. Cells in S-phase were labelled after small pieces of the lesions were incubated in tissue culture medium that contained 5-bromo-2'-deoxyuridine (BrdU). The labelling of DNA was analysed using the labelling index and pattern. Although the malignant diseases tended to show a higher DNA labelling index, neither this nor the loss of polarity alone was associated with malignancy. However, a higher DNA labelling index together with a loss of polarity was characteristic for malignancy.

Bowen's Disease↗

PubMed2005

Bowen's disease of the nipple-a new method of treatment.

Squamous cell carcinoma in situ (Bowen's disease) is a common skin condition but has only rarely been described on the nipple. All reported cases have been treated with wide local excision and observation. A new treatment for Bowen's disease is photodynamic therapy. This has been reported as being able to treat Bowen's disease in other sites effectively with an acceptable local recurrence rate. We describe two patients presenting with itching and scaling of the nipple which were histologically proven Bowen's disease, one of these patients was treated successfully with a combination of photodynamic therapy and cryotherapy: this is the first time such a lesion has been treated in this way.

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PubMed2006

The characteristics of human papillomavirus expression and cell proliferation in actinic keratosis and Bowen's disease of the skin.

The aim of our study was to elucidate the characteristics of HPV expression and cell proliferation in actinic keratosis and Bowen's disease of the skin. We examined immunocompetent patients with premalignant lesions of the skin such as actinic keratosis and Bowen's disease. 10 patients were involved in each group. Clinical study included gross features of lesion, growth rate, colour, size. Paraffin sections from biopsy specimens were were stained by hematoxylin-eosin and von Gieson. Immunohistochemistry was performed using monoclonal antibodies against HPV, oncoprotein p53, anti-apoptotic protein Bcl-2, proliferation marker PCNA. Strongly, moderately and weakly positive cells were counted. Actinic keratosis and Bowen's disease failed to show the specific clinical features, therefore, they can not be diagnosed based on clinical signs only and morphological examination seems to be mandatory. The immunohistochemical study has showed that in both actinic keratosis and Bowen's disease HPV was positive in 60%, and 40% were HPV-negative suggesting the similar incidence of HPV infection in these premalignant lesions. Our results suggest that HPV(+)/p53(+) types of actinic keratosis and Bowen's disease are characterized by higher proliferation activity in comparison to HPV(-)/p53(+) types, and expression of Bcl-2 is associated with HPV-negativity, therefore, these premalignant lesions of the skin require immunohistochemical examination with evaluation of expressions of human papillomavirus, proliferation marker PCNA and anti-apoptotic protein Bcl-2. The differential diagnosis of actinic keratosis and Bowen's disease should be based on the following immunohistochemical criteria: incidences of positivity for p53, Bcl-2 and PCNA are similar, but expression intensity and anatomical localization are different: their expressions are higher in Bowen's disease, positive cells are found primarily in upper epidermis in actinic keratosis, while whole epithelium is involved in Bowen's disease.

Adult↗