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Pathology of Bowen's Disease

Dr Sampurna Roy MD              


Dermatopathology Case 119

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.


Further reading

Bowen's Disease: A Six-year Retrospective Study of Treatment with Emphasis on Resection Margins.

Huge Bowen's disease: A pitfall of topical photodynamic therapy.

Immunosuppressive and Cytotoxic Cells in Invasive vs. Non-invasive Bowen's Disease.

Bowen's Disease masquerading clinically as a follicular cyst in a renal transplant recipient.

Detection of mucosal human papilloma virus DNA in bowenoid papulosis, Bowen's disease and squamous cell carcinoma of the skin.

Invasive squamous cell carcinoma arising in refractory perianal Bowen's disease in a HIV-positive individual.

Intraepithelial sebaceous carcinoma of the eyelid misdiagnosed as Bowen's disease.

Bowen's disease involving the urethra.

Premalignant and early squamous cell carcinoma.

Human papillomavirus associated with Bowen's disease of the finger.

Pigmented Bowen's disease mimicking cutaneous melanoma: clinical and dermoscopic  aspects.

Bowen's disease of the nail.

Perianal Bowen's disease





Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)



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