Centro Studi GISED

Bowen’s disease

Bowen’s disease is described as a precancerous lesion. The lesion presents itself as an erythema plaque of slow growth, with a well-defined border. The plaques are usually slightly scaly and crusty.

I would like to speak with you about a case of Bowen’s Disease: A year ago, my mother (80 years) notice a mark on her left cheek, which was slightly darker than her skin and about 1cm in size. In the middle of it there was a little scab and shortly after a little wart about 1mm, which was very itchy and uncomfortable and frequently came off. She was in the care of a dermatologist for months without results, on the understanding that treatment times can vary. About 2 weeks ago, the surgeon she was told to visit decided to take a sample for a histological examination and removed the wart. The results of the test were positive for Bowen’s Disease. Her general practitioner has advised against surgical intervention because a cutaneous transplant would be necessary and given that my mother is old and diabetic, there would probably be problems with the skin graft being accepted. Can I ask you for your opinion on the possibilities of a surgical intervention and any risks of metastases if a surgical intervention is not possible and, given my mother’s age, any possibilities of the illness worsening. Thank you and best regards.

Dear Writer, your general practitioner is correct, diabetes renders the recovery of a surgical wound more difficult and increases the chances of your mother contracting an infection, yet Bowen’s Disease is a tumour of the skin and if not adequately treated could result in more serious consequences. I would advise you therefore, to consult your dermatologist again and in light of the histological diagnosis and case history of the patient he or she will be able to advise you on the best course of treatment (it’s possible to use alternative methods other than surgical removal). Best regards, Dr Lorenzo Peli – GISED.

Hi, my name’s (…) and I have a few questions that I would like to ask you in light something that affects me personally. My mother is 63 and had an operation in September 2002 for a basalioma on her spine that she had had for about 5 years. The operation involved a general anaesthetic and the basalioma was about 2.5cm in size. From the results of a histological examination the presumed basalioma was now “in situ carcinoma of the skin – Bowen’s Disease” complete excision, modest melanocytic hyperplasia. I would like to know if this type of tumour can metastasise and if yes, what’s the percentage risk of it also affecting the lymph nodes. Is it a case of undergoing radiotherapy or chemotherapy? Awaiting your kind response, thank you and best regards.

Basalioma and Bowen’s Disease can have very similar characteristics and therefore a histological examination provides, in hindsight, a definite diagnosis on the nature of the lesion. Bowen’s Disease is a skin tumour that remains confined to the skin for long periods of time, for this reason removal of the lesion provides, in general, a complete recovery without complications. The definition “in situ carcinoma of the skin” underlines the fact that the tumour is limited just to the upper layers of the skin. The risk of locoregional or remote metastases in this phase is very low to non-existent. It can be reasonably maintained that as the problem has already been resolved with an intervention there is no necessity to undergo other treatments. However, without direct involvement in the case we advise you to scrupulously follow the advise of the doctors who have been following the patient, particularly as far as check up visits are concerned (follow up visit). Best regards, Dr Lorenzo Peli – GISED.

I’m a man of 38 years and I have recently been diagnosed with Bowen’s Disease, which in my case has appeared on my shoulder. The skin is reddened and at times little scabs form. In January or February 2003, I will definitely have to undergo a surgical intervention to remove the tumour. I wanted to know what the consequences are of this disease and if there are risks involving internal organs. Thank you.

Bowen’s Disease is a tumour of the skin limited initially just to the upper layers (epidermis) and by virtue of it’s superficial position it is normally treatable without complications - provided that it has been treated early. The preferred treatment is surgical removal by local anaesthetic. In unusual cases, alternative treatments like cryotherapy, diathermocauterisation or laser photocoagulation. We advise you, in the short term, to undergo surgical removal. Best regards Dr Lorenzo Peli. – GISED.

My mother of 88 years had a round lesion on her leg treated with cryotherapy at least 8-10 years ago. The lesion has never come back but numerous other lesions defined as senile dyskeratosis by the derm-oncologist that she is following are appearing. Now my mother is afflicted with sciatica (?) resistant to all treatments and has been for the last 2 months. At the same time the number of dyskeratoses had increased considerably. Could there be a relation between this and her old problem or not? It’s noteworthy to mention that for a few years she has been faintly positive for CEA, but in the absence of symptoms and with negative results from an abdmominal-pelvic ultrasound scan the doctor in charge doesn’t believe that other examinations are necessary. I would be very grateful if you could give me your professional opinion.

Dear Writer, has a biopsy of this lesion ever been carried out? The term ‘senile dyskeratosis’ is very general; it could indicate multiple actinic keratoses, benign lesions favoured by chronic photo-exposure with a risk of degeneration into epithelioma. These indications, however, shouldn’t have anything to do with your mother’s sciatica or the increase seen in the blood test. On the legs of old people you can also find cases of Stucco Keratoses, benign lesions, variations of Seborrheic Keratosis, for which the treatment required is surgery or cryotherapy. Best regards, Dr Anna di Landro – GISED.