CA: A Cancer Journal for Clinicians, Vol 27, 160-166, Copyright
© 1977 by American Cancer Society
Bowen's Disease
Robert R. Rickert M.D.1,
Roger H. Brodkin M.D.2, and
Robert V. P. Hutter M.D.3
1 Co-Director, Department of Pathology, Saint Barnabas Medical Center, Livingston, New Jersey and Adjunct Associate Professor of Pathology, College of Physicians and Surgeons of Columbia University, New York, New York.
2 Attending Dermatologist, Saint Barnabas Medical Center, Livingston, New Jersey and Clinical Professor of Dermatology, College of Medicine and Dentistry, New Jersey Medical School, Newark, New Jersey.
3 Director, Department of Pathology, Saint Barnabas Medical Center, Livingston, New Jersey and Adjunct Professor of Pathology, College of Physicians and Surgeons of Columbia University, New York, New York.
The lesion described by John Bowen as "precancerous dermatosis" remains, we believe, a specific clinicopathological entity. Bowen felt that the precancerous nature of this disease related to its ultimate conversion to an invasive cutaneous lesion. The observations of Graham and Helwig greatly expanded the concept of precancer in Bowen's disease. These and other studies have identified the most significant feature of Bowen's disease, that is, its relationship with the simultaneous or subsequent development of additional cutaneous and extracutaneous cancers. While the magnitude of the risk cannot be accurately estimated, it seems justified at this time to regard Bowen's disease as a cutaneous sign of a predisposition to cancer. Although a recent report from Denmark fails to confirm this association, it is Unlikely that the relationship is purely a statistical artifact. We therefore believe that the term Bowen's disease should be restricted to those lesions that fulfill certain clinical and histological criteria and should not be used as a synonym for all types of intraepithelial squamous cell carcinoma of cutaneous and mucocutaneous surfaces or for solar keratoses with Bowenoid features. The therapeutic management of Bowen's disease presents no special problem. The patient, however, should have continuous clinical surveillance because of the possibility that another, more serious neoplasm may either co-exist or subsequently develop.
