Skip to content

Content

Home
Patient case
Patient Case: Bowen’s Disease (Intraepidermal Squamous Cell Carcinoma)

Patient Case: Bowen’s Disease (Intraepidermal Squamous Cell Carcinoma)

Discussion

A 65-year-old retired school teacher presents to the dermatology clinic with a persistent, slowly enlarging red scaly patch on her left forearm. She first noticed the lesion over a year ago, initially as a small, rough, pinkish spot, but it has progressively grown to approximately 3 cm in diameter. She reports occasional mild itching but no pain or bleeding.

She has fair skin and a history of significant sun exposure due to outdoor gardening and previous holidays in sunny regions. She has no personal history of skin cancer but recalls that her father had a "skin growth" removed in his later years. She has no history of immunosuppression.

On examination, there is a well-demarcated, erythematous, scaly plaque with irregular borders on the dorsum of her left forearm. The lesion does not blanch with pressure and has a rough, slightly thickened texture. A dermoscopic examination reveals glomerular vessels and scale. A punch biopsy confirms Bowen’s disease (squamous cell carcinoma in situ).

The patient is counseled on treatment options, including topical 5-fluorouracil, cryotherapy, photodynamic therapy, and surgical excision, and is advised on regular skin surveillance to monitor for any new suspicious lesions.

Questions
  1. What is the most common cause of Bowen’s disease?
    a) Genetic predisposition
    b) Chronic sun exposure and UV radiation
    c) Fungal skin infection
    d) High carbohydrate diet
  2. Which of the following best describes the clinical presentation of Bowen’s disease?
    a) A painful, ulcerated nodule with pus discharge
    b) A well-defined, slowly growing erythematous scaly plaque
    c) A smooth, dome-shaped skin-colored papule
    d) A dark brown, rapidly changing pigmented lesion
  3. Which of the following is the most appropriate treatment for Bowen’s disease?
    a) Topical steroids
    b) Wide local excision or topical chemotherapy
    c) Oral antibiotics
    d) Radiation therapy as first-line treatment
  4. Why is it important to treat Bowen’s disease promptly?
    a) It causes significant pain and discomfort
    b) It has a high risk of metastasis to distant organs
    c) It has the potential to progress to invasive squamous cell carcinoma
    d) It is highly contagious and can spread to close contacts
Reveal answers

Answers

  1. (b) Chronic sun exposure and UV radiation
    • Bowen’s disease is strongly associated with long-term ultraviolet (UV) radiation exposure, particularly in fair-skinned individuals. Other risk factors include HPV infection and immunosuppression.
  2. (b) A well-defined, slowly growing erythematous scaly plaque
    • Bowen’s disease typically presents as a slow-growing, red, scaly patch or plaque that can mimic other dermatologic conditions such as psoriasis or eczema.
  3. (b) Wide local excision or topical chemotherapy
    • Treatment options include surgical excision, cryotherapy, topical 5-fluorouracil or imiquimod, and photodynamic therapy. The choice depends on lesion size, location, and patient factors.
  4. (c) It has the potential to progress to invasive squamous cell carcinoma
    • Although Bowen’s disease is confined to the epidermis, if left untreated, it can progress to invasive squamous cell carcinoma, which has the potential for local and distant spread.