Pigmented Bowen’s Disease

Dr Ian Katz, March 2013www.southernsunpathology.com.au

What is Bowen’s disease?

• It is squamous cell carcinoma (SCC) that is still within the epidermis– i.e. is not invasive into the dermis

My classification of SCC

• Possibly two different pathways– Actinic pathway– Bowen’s pathway

Actinic Pathway

• Actinic keratosis• ?Intermediate lesion• Intraepidermal SCC• ? Early invasive SCC• SCC

Bowen’s pathway

• ? Precursor or early lesion• Bowen’s disease• ?possible invasive BD• Invasive BD type SCC

Invasive Bowen’s disease

• Can be really difficult to tell when there is early invasion

• Often extensive follicular involvement– Careful with topical therapy in hair-bearing skin

• Invasive BD type SCC said to have worse prognosis than regular SCC for the same depth (difficult to find this reference)

Who was Bowen

• John T Bowen, an American dermatologist• 1857–1940

The case

• 80 yo old man• Lots of skin cancers• Scaly, lightly pigmented lesion on right

forearm• No idea how long it had been there

Dermatoscopic features

• Scaly surface• Pigment but no network• Dot vessels

• All highly suggestive of pigmented Bowen’s disease

Histological features

• Full thickness dysplasia of epidermis with no evidence of invasive SCC

Treatment options

• Many options, none right or wrong• Depends on many doctor, patient factors eg– Affordability– Compliance– Equipment– Cost– Etc etc

Treatment options

• Excision• Curettage• Efudix• Aldara• Photodynamic therapy• Cryotherapy– And probably a few more

Dr Ian Katz

• Southern Sun Pathology• Sydney, Australia