Histologic Variants of Squamous Cell Carcinoma of the Skin

Margaret H. Rinker, MD; Neil A. Fenske, MD; Leigh Ann Scalf, MD, and L. Frank Glass, MD, Division of Dermatology and Cutaneous Surgery, Department of Internal Medicine at the University of South Florida, Tampa, Fla.

Cancer Control. 2001;8(4) 

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Bowen's Disease

Bowen's disease, also known as SCC in situ, was first described by John Bowen in 1912. It presents as a slow-growing, sharply demarcated erythematous scaly patch. Hyperkeratosis, crusting, fissuring,or pigmentation may be associated.Although Bowen's disease is usually seen in sites of chronic sun exposure,it can occur on any mucocutaneous surface. Tumor size ranges from a few millimeters to several centimeters.[4] It is common in elderly patients, and the male-to-female ratio is approximately equal. When it occurs on the penis,it is referred to as erythroplasia of Queyrat, a disease that tends to occur in men who are uncircumcised and appears as solitary or multiplered, smooth, velvety plaques.[2]

Bowen's disease is characterized histologically by hyperkeratosis,parakeratosis, and acanthosis with thickened and elongated rete ridges. Scattered atypical cells and frequent mitoses are present.The keratinocytes show loss of maturity and polarity, giving the epidermis a disordered or "windblown"appearance. The dermal epidermal junction is intact, which distinguishes Bowen's disease from invasive SCC. There may be a moderate inflammatory infiltrate of lymphocytes and histiocytes.[4]

It has been previously reported that Bowen's disease may be associated with internal malignancy;however, recent studies have failed to confirm this.[4]

Treatment by excision or destruction is recommended.Theoretically,there is no risk of metastasis with Bowen's disease because it is confined to the epidermis.If not treated,however, it could progress to invasive SCC, which then carries a risk of metastasis.[2]

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