Bowen's disease (BD) is generally regarded as a premalignant dermatosis.1-3 If untreated, 3% to 5% of patients may develop invasive carcinoma, which is capable of metastasizing and may even cause death.3, 4 Clinically, the lesions of BD present as a scaly, slightly elevated, erythematous plaque with surface fissures and foci of pigmentation. These lesions affect fair-skinned individuals more frequently and are equally distributed on the exposed and nonexposed parts of the body. Microscopically, BD is a form of carcinoma in situ characterized by full-thickness involvement of the epidermis and the pilosebaceous epithelium by atypical keratinocytes. The papillary dermis shows a dense, chronic, inflammatory infiltrate compound of lymphocytes, histiocytes, and plasma cells.
Bowen's disease with invasive carcinoma (BD-CA) is not well recognized by clinicians because of its rarity and lack of specific clinical features. The lesion is often diagnosed as seborrheic keratosis, basal cell carcinoma, squamous cell carcinoma, BD,
Kao GF. Carcinoma Arising in Bowen's Disease. Arch Dermatol. 1986;122(10):1124-1126. doi:10.1001/archderm.1986.01660220042010