[12] Bowen's Disease Flashcards
What is Bowen’s disease also known as?
SCC in situ
What is Bowen’s disease?
A neoplastic skin disease that can be considered as an early stage or intra-epidermal form of SCC
What is the risk of progression from Bowen’s disease to SCC in typical cases?
Around 3%
What is Bowen’s disease a malignancy of?
Keratinocytes in the epidermal layer
What are the risk factors for Bowen’s disease?
- Sun damage
- Other irradiation damage
- Carcinogens
- HPV
- Immunosuppression
- Chronic skin injury or dermatoses
What other forms of radiation damage can increase risk of Bowen’s disease?
- Radiotherapy
- Photochemotherapy
- Sunbeds
Give a carcinogen that can cause Bowen’s disease?
Arsenic
How does Bowen’s disease typically present?
A slow growing erythematous hyperkeratotic patch or plaque with an irregular border
What are the features of Bowen’s disease?
- Erythematous
- Hyperkeratotic/scaling
- Plaque/patch
- Irregular border
- Well defined
What additional features may be present in Bowen’s disease?
Crusting/erosion
How big generally is Bowen’s disease?
A few cm
What is the size of the Bowen’s disease proportional to?
The duration
What is the main symptom of Bowen’s disease?
Bleeding of the lesion
Where is Bowen’s disease most commonly found on the skin?
Sun exposed areas
How is Bowen’s disease typically diagnosed?
Clinically with a dermatoscope
If there is doubt about Bowen’s disease what is required for histological diagnosis?
Punch biopsy
What are the differentials for Bowen’s disease?
- Discoid eczema
- Psoriasis
- Lichen planus
- Actinic keratosis
- Superficial BCC
- Malignant melanoma
What is the recurrence rate for all treatments for Bowen’s disease?
5-10%
What influences the choice of treatment in Bowen’s disease?
- Age of patient
- Number of lesions
- Size of lesions
- Location of the lesions
What are the treatment options for Bowen’s disease?
- Topical treatments
- Cryotherapy
- Surgery
- Photodynamic therapy
What is usually the first line therapy for Bowen’s disease?
Topical treatment with 5-FU cream
When is 5-FU cream useful in Bowen’s disease?
For large lesions with a history of poor healing
What can improve the efficacy of 5-FU in Bowen’s disease?
Preceding laser or cryotherapy
What is used in cryotherapy of skin lesions?
Liquid nitrogen
What are the advantages of cryotherapy in Bowen’s disease?
- Simple
- Quick
- Effective
What are the different surgical techniques for treating Bowen’s disease?
- Curettage with cautery
- Surgical excision
- Moh’s microqurgery
What happens in curettage of Bowen’s disease?
Abnormal skin is scraped off under local anaesthetic and additional tissue is destroyed with electrocautery
What excision margin is recommended in excisional surgery of Bowen’s disease?
5mm
When is Moh’s microsurgery useful in Bowen’s disease?
For areas that require skin sparing e.g. fingers, nails and penis
What is photodynamic therapy for Bowen’s disease?
Preparing by removing crust/scale and using a photosensitising cream. Lesion is then exposed to a light source which burns away the area
When is photodynamic therapy useful in treating Bowen’s disease?
Treating large lesions
What are the advantages of photodynamic therapy for Bowen’s disease?
Better tolerated and better cosmesis than cryotherapy
What is the disadvantage of photodynamic therapy in Bowen’s disease?
May be painful
What is the main complication of Bowen’s disease?
Progression to invasive SCC
