From the Guidelines
Bowen disease is a type of early skin cancer, specifically an early form of squamous cell carcinoma that hasn't yet invaded deeper tissues. It appears as a slow-growing, persistent, red, scaly patch on the skin that may resemble eczema or psoriasis. Bowen disease typically occurs on sun-exposed areas like the face, neck, and hands, but can also develop on covered areas including the genitals. The condition is usually caused by long-term sun exposure, human papillomavirus (HPV) infection, or arsenic exposure.
Treatment Options
Treatment options for Bowen disease include:
- Topical medications like 5-fluorouracil or imiquimod
- Cryotherapy (freezing)
- Curettage and electrocautery (scraping and burning)
- Photodynamic therapy
- Surgical excision According to the British Association of Dermatologists' guidelines for the management of squamous cell carcinoma in situ (Bowen's disease) 2014 1, the suggested scoring of the treatments listed takes into account the evidence for benefit, ease of application or time required for the procedure, wound healing, cosmetic result, and current availability/costs of the method or facilities required.
Risk of Progression
Without treatment, there's approximately a 3-5% risk that Bowen disease will progress to invasive squamous cell carcinoma 1. Regular skin examinations are important for early detection, and sun protection measures help prevent recurrence or new lesions from developing.
Evidence-Based Recommendation
The most effective treatment for Bowen disease is surgical excision, which has a high cure rate and low risk of recurrence 1. However, other treatment options like topical medications, cryotherapy, and photodynamic therapy may also be effective and have a better cosmetic outcome. The choice of treatment depends on the size, location, and number of lesions, as well as the patient's overall health and preferences.
From the Research
Definition and Characteristics of Bowen Disease
- Bowen disease is an in-situ squamous cell carcinoma of the epidermis 2
- It is considered a precancerous condition that can progress to invasive squamous cell carcinoma if left untreated 2, 3
- The etiology of Bowen disease is multifactorial, with a high incidence among Caucasians, and it is common in photo-exposed areas of the skin 2
Diagnosis of Bowen Disease
- Histopathology is the gold standard diagnostic modality to confirm the diagnosis of Bowen disease 2
- Immunohistochemistry, dermoscopy, and reflectance confocal microscopy are adjuvant modalities used in the diagnosis of Bowen disease 2
Treatment Options for Bowen Disease
- Treatment options for Bowen disease include topical chemotherapy, surgical modalities, light-based modalities, and destructive therapies 2, 4
- Topical application of imiquimod 5% cream has been shown to be effective in treating Bowen disease, with complete clinicopathologic regression in 80% of cases 5
- Photodynamic therapy (PDT) is also an effective treatment option for Bowen disease, with acceptable clinical response rates and lower recurrence rates compared to conventional therapies 6
- A multicenter randomized controlled trial found that 5-fluorouracil cream is noninferior to surgical excision and is associated with better cosmetic outcomes 4