Bowen's disease is an intraepidermal squamous cell carcinoma of the skin. The disease occurs at the age of 70-80 years, more often in women, usually on the trunk, upper limbs and in the perineum. Its development is associated with the action of ultraviolet radiation, traumatization of the skin, contact with arsenic (medicines, industrial hazards).
Two forms of the disease are considered: one occurs on places exposed to the sun, and the other occurs on closed areas of the skin. The latter form, according to the authors, is more often associated with patients taking arsenic drugs. In addition, Bowen's disease can develop against the background of foci of Lewandowski-Lutz epidermodysplasia. A number of authors consider HPV (human papilloma virus) as an important factor in the development of Bowen's disease. Literature data on the frequency of association of Bowen's disease with malignant neoplasms of internal organs are quite contradictory. In particular, the authors, who indicate the presence of such a connection, found cancer of internal organs in 57% of those who died from Bowen's disease.
However, in subsequent studies, a significant increase in the frequency of associated cancer of internal organs was observed only in patients with foci of lesions on closed areas of the skin (33%), while with Bowen's disease on open areas of the skin, the frequency of visceral cancer was only 5%. The clinical picture of Bowen's disease is characterized more often by solitary and in 1/3 of cases by multiple lesions. The pathological process can be located on any part of the skin: on the trunk, upper limbs, including the fingers and nail beds, in the perineum.
Eczema-like, hyperkeratotic, warty. Uneven growth of foci on the periphery, variegation (alternation of erosions, atrophy, hyperkeratosis and elevated marginal zone) are characteristic. On the surface of erosions there are scales-crusts, wetting, during the transformation into cancer, a dense nodule appears, which later disintegrates. Any area is affected.
Initially, lesions are represented by small red spots, or a slightly infiltrative plaque of irregular contours, or a rounded shape with slight peeling. Plaques can be formed by the fusion of reddish lenticular papules and nodes of different sizes. Located on the surface of the focus, white or yellow scales are easily separated without signs of bleeding, revealing a red wetting surface. The focus has clear boundaries and gradually rises above the skin level. As its size increases, the flat surface becomes hyperkeratotic and in some areas is covered with crusts. Important clinical signs can also be uneven growth of the focus on the periphery, its variegation (due to areas of atrophy, hyperkeratosis, warty growths), elevation of the marginal zone. The size of the focus varies from 2 mm to the size of a child's palm. Pigmatic form of Bowen's disease occurs in 2% of cases. Bowen's disease of the nail bed is manifested by peeling around the nail plate, onycholysis or erosion with crusts and discoloration of the nail. Bowen's disease in skin folds is characterized by erythematous dermatitis with a sharp, unpleasant odor; chronic non-specific dermatitis or dark spots. The transformation of Bowen's disease into invasive squamous cell carcinoma is accompanied by an ulcer within the plaque.