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October 1986

Carcinoma Arising in Bowen's Disease

Author Affiliations

Department of Dermatopathology Armed Forces Institute of Pathology 14th Street and Alaska Avenue Washington, DC 20306-6000

Arch Dermatol. 1986;122(10):1124-1126. doi:10.1001/archderm.1986.01660220042010

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,