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Bowen disease
Background
Overview
Definition
Bowen disease, also known as SCC in situ, is a precancerous skin condition characterized by the presence of atypical squamous cells.
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Pathophysiology
The exact pathophysiology of Bowen disease is not fully understood, but chronic UV radiation exposure, certain genetic mutations, and HPV play a role in the abnormal and uncontrolled growth of squamous cells.
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Epidemiology
The incidence of Bowen disease in Canada is estimated at 28 per 100,000 in males and 22 per 100,000 in females. The incidence of Bowen disease in the Netherlands is estimated at 8.1 per 100,000 person-years.
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Risk factors
Potential risk factors for Bowen disease include prolonged exposure to sunlight and infection with specific strains of HPV.
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Disease course
Clinically, Bowen disease presents as persistent, scaly, red, or pink patches on the skin that may resemble other skin conditions such as psoriasis or eczema.
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Prognosis and risk of recurrence
The prognosis of Bowen disease is generally good, as most cases do not progress to invasive SCC. However, due to the risk of progression, diligent monitoring and treatment are necessary.
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Guidelines
Key sources
The following summarized guidelines for the evaluation and management of Bowen disease are prepared by our editorial team based on guidelines from the British Association of Dermatologists (BAD 2023), the German Society of Dermatology (DDG/DKG/DeCOG 2023), the U.S. Preventive Services Task Force (USPSTF 2023,2018), the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS/ASMS/ASPS/AAO-HNSF/ASDS/ACMS/AAD/ASOPRS 2021), the British Photodermatology Group (BPG/BAD ...
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Screening and diagnosis
Diagnostic procedures
Biopsy: as per BAD 2023 guidelines, consider performing a punch biopsy or diagnostic excision when clinical and dermoscopic features are not sufficient for diagnosis of SCC in situ.
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Curettage
Medical management
Conservative management: as per BAD 2023 guidelines, consider offering conservative measures, including moisturizers (preferably urea-based) and skin surveillance, in patients with poor health and multiple SCC in situ lesions, especially on the lower legs, where there is a greater risk of long-term ulceration after treatment. Perform a biopsy if SCC is suspected.
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Topical 5-FU
Topical imiquimod
Topical tazarotene
Therapeutic procedures
Photodynamic therapy: as per BAD 2023 guidelines, offer conventional, red-light photodynamic therapy as a treatment option in patients with SCC in situ, particularly for poorly healing or cosmetically sensitive skin sites, multiple lesions, and large lesions.
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Cryotherapy
Curettage with cautery
Laser therapy
Radiotherapy
Surgical interventions
Standard surgical excision: as per BAD 2023 guidelines, perform standard surgical excision in patients with SCC in situ if there is diagnostic uncertainty regarding an invasive disease.
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Mohs micrographic surgery
Patient education
Preventative measures
Sun protection
As per USPSTF 2018 guidelines:
Counsel persons with fair skin types aged 6 months to 24 years and parents of young children about minimizing exposure to UV radiation to reduce the risk of skin cancer.
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Offer counseling selectively in adults > 24 years with fair skin types about minimizing exposure to UV radiation to reduce the risk of skin cancer, taking into consideration the presence of risk factors for skin cancer.
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Follow-up and surveillance
Skin reconstruction after tumor resection, timing: as per AAD/AAFPRS/AAO-HNSF/…/ASPS 2021 guidelines, consider performing reconstructive surgery in a delayed (asynchronous) fashion in adult patients after skin cancer resection.
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Skin reconstruction after tumor resection (perioperative antibiotics)
Skin reconstruction after tumor resection (perioperative antithrombotics)
Skin reconstruction after tumor resection (perioperative analgesics)
Skin reconstruction after tumor resection (follow-up)
Follow-up