Pathology of Bowen's Disease - Dr Sampurna Roy MD

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Pathology of Bowen's Disease

Diagnosis: Bowen's Disease

Bowen's disease (squamous cell carcinoma in-situ) presents as scaly erythematous plaque on the sun-exposed skin in elderly patients.

Etiological factors include prolonged exposure to solar radiation, ingestion of chemical agent (arsenics) or human papillomavirus infection.

Arsenic exposure: Major public health hazard - Pathology of Arsenic Poisoning.

Histological appearances:

- There is full thickness dysplasia of the squamous epithelium.

- Pilosebaceous epithelium may be involved by atypical keratinocytes.

- Disorderly maturation of the epidermis.

- Overlying parakeratosis and loss of granular layer.

- Mitotic figures, multinucleated cells and dyskeratotic cells are present.

- Stromal inflammation may be present in the dermis and occasionally features of regression is seen.

- Histological patterns include- Psoriasiform pattern, atrophic form, verrucous hyperkeratotic type, irregular variant, pigmented type and pagetoid variant.

Rarely mucinous and sebaceous metaplasia may be noted.

Differential diagnosis includes in-situ superficial spreading melanoma and Extramammary Paget's disease.

Note, both in case of actinic keratosis and in Bowen's disease specific comment should be made on whether the nearest peripheral margins are free or involved.

Bowenoid papulosis noted in genitalia is histologically similar to squamous cell carcinoma in-situ.

However, features favouring the diagnosis of bowenoid papulosis include presence of numerous mitotic figures in metaphase, basophilic inclusions in the granular layer and koilocytes.

Erythroplasia of Queyrat represents squamous cell carcinoma in situ presenting on the mucous membranes of the glans penis,vulva and oral mucosa.

Differential diagnosis: Bowenoid papulosis is a benign condition in contrast to the malignant behaviour of Bowen's disease and Erythroplasia of Queyrat (EQ).

Macroscopically bowenoid papulosis presents as multiple small brown papules usually on the penile shaft.

Bowen's disease and Erythroplasia of Queyrat are well defined erythematous plaques in a variety of sites. Bowenoid papulosis and Erythroplasia of Queyrat are seen primarly in men.

Bowen's disease occurs equally in men and women.