Bowen’s Disease (Squamous Cell Carcinoma in situ) as a Skin Marker for Internal Malignancy: A Case-Control Study (2023)


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American Journal of Preventive Medicine

Volume 6, Issue 4,

July–August 1990

, Pages 238-243

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Bowen’s disease has been viewed as a skin marker for internal malignancy by dermatologists for decades. If substantiated, it certainly would help in early detection of an occult malignancy. We conducted a matched case-control study to evaluate the significance of this link. Ninety patients with Bowen’s disease diagnosed between 1972 and 1986 were selected for study. These patients were matched by age, sex, race, and date of biopsy for diagnosis (or treatment) to 90 other patients chosen as controls. Six patients in the Bowen’s disease group and three patients in the control group had internal malignancy during the period after the date of biopsy or treatment (P > 0.4). The present study cannot substantiate the claim that Bowen’s disease is a skin marker for internal malignancy.

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Cited by (19)

  • Dermatoepidemiology

    2005, Journal of the American Academy of Dermatology

    Dermatoepidemiology is an important emerging discipline in dermatology. This article reviews clinical and analytic epidemiology pertinent to reading, interpreting, and critically examining the literature, and presents an overview of evidence-based dermatology as a starting point for further study.

    At the conclusion of this review, readers should be familiar with basic clinical epidemiologic principles pertinent to dermatology, attain conceptual familiarity with the strengths and weaknesses of epidemiologic study designs (eg, case-control, cohort, and randomized controlled trials), identify bias and confounding as potential threats to study validity, and recognize evidence-based dermatology as an important tool for medical decision making.

  • Digital syndactylization for the treatment of interdigital squamous cell carcinoma in situ (Bowen disease)

    2004, Journal of Foot and Ankle Surgery

    Bowen disease, or squamous cell carcinoma in situ, has been described as a premalignant intraepidermal lesion of the skin. Although more frequently occurring on limbs, interdigital presentation of squamous cell carcinoma in situ in the foot has been rarely reported, likely because of undetected development. Excision has been recommended as the treatment of choice; however, removal of these lesions from intertriginous skin may present few options for skin closure. Interdigital syndactylization may be an acceptable option for the treatment of interdigital manifestations of Bowen disease. The authors present a case of interdigital squamous cell carcinoma in situ successfully treated with excision and digital syndactylization. At the 2-year follow-up, there was no recurrence and no digital deformities.

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  • Surgical considerations in anal cancer

    2004, Surgical Oncology Clinics of North America

  • Giant bowen's disease, with dermic invasion after 65 years of evolution

    2002, Actas Dermo-Sifiliograficas

    .—La enfermedad de Bowen es una forma de carcinoma espinocelular in situ que afecta a todo el grosor de la epidermis e invade las unidades pilosebáceas. Aunque suele permanecer in situ durante largos períodos de tiempo, del 3% al 5% de los pacientes no tratados pueden desarrollar un carcinoma invasivo.

    Presentamos el caso de una mujer de 92 años con una enfermedad de Bowen de 65 años de evolución que acabó desarrollando un carcinoma invasivo.

    .—Bowen's disease is a form of squamous cell carcinoma in situ that shows full-thickness involvement of the epidermis, and the pilosebaceous units. Although it may remain in situ for long periods, about 3% to 5% of untreated patients may develop invasive carcinoma.

    We report the case of a 92-year-old woman with a Bowen's disease of 65-year duration which developed an invasive carcinoma.

  • Risk factors of non-melanoma skin cancer in United States veterans patients: A pilot study and review of literature

    1999, Journal of the European Academy of Dermatology and Venereology

    ObjectiveTo identify risk factors of non-melanoma skin cancer (NMSC) in US veterans patients.

    BackgroundThere are an estimated one million new NMSC cases annually in the United States alone. While other studies with varying foci have evaluated risk factors in different subsets of the general populace, none have examined veterans as a group with potentially unique exposures and risks.

    MethodsAn investigation of risk factors for skin cancer through questionnaire and physical examination on 145 veteran patients with skin cancer and 59 veteran patients without a history of skin cancer was conducted.

    ResultsParents' ethnicity, actinic keratosis on the face or other anatomic sites, solar elastosis of the neck, facial telangiectasias, age of first sunburn, and residency in Indiana were risk factors significantly associated with the development of skin cancer. Other possible risk factors included smoking and radiation therapy.

    ConclusionsWe documented several risk factors which significantly increased the chance of developing skin cancer among veterans. These included ethnic background and solar damage of the skin among others. A review of the literature confirms these risks in the general population, but also further study is warranted to address risk factors like smoking and radiation, particularly in veterans populations. Identification of pertinent risk factors will help to identify high risk individuals, allow detection of new skin cancer at its earliest stage, and develop a profile of favorable lifestyle characteristics that reduce NMSC risk.

  • Bowen's disease (squamous cell carcinoma in situ) in Kauai, Hawaii: A population-based incidence report

    1994, Journal of the American Academy of Dermatology

    Background: The incidence of Bowen's disease (squamous cell carcinoma in situ) is rarely investigated.

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    Objective: Our purpose was to report the incidence of Bowen's disease in a defined Caucasian population in Kauai, Hawaii.

    Methods: We conducted a prospective 5-year population study.

    Results: We found 71 Caucasian residents, 44 men and 27 women, who had an initial episode of Bowen's disease during the 5-year period. The average annual incidence rate per 100,000 Caucasian residents of Kauai, standardized to the 1980 U.S. Caucasian population, was 174 for men and 115 for women, with a combined rate of 142. The incidence increased in older age groups. The mean age of the patients was 65.2 years. The most common anatomic site was the extremities. Subsequent Bowen's disease occurred in eight patients (11.3%). Recurrence after treatment developed in only one patient (1.4%). Twenty-six patients (36.6%) had concurrent skin cancers, either basal cell carcinoma or squamous cell carcinoma, or both. There was no increased incidence of internal malignancy.

    Conclusion: The incidence of Bowen's disease is high in Caucasian residents of Kauai and is 10 times higher than that reported from a northern Midwestern community. Kauai's intense ambient UV light and greater opportunity for year-round outdoor activities likely contributes to this higher rate.

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Copyright © 1990 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.


What is squamous cell carcinoma in situ Bowen's disease? ›

Bowen's disease is a very early form of skin cancer that's easily treatable. The main sign is a red, scaly patch on the skin. It affects the squamous cells, which are in the outer layer of skin, and is sometimes referred to as squamous cell carcinoma in situ.

What does squamous cell carcinoma in situ mean? ›

(SKWAY-mus sel KAR-sih-NOH-muh in SY-too) A condition in which abnormal cells are found in the tissues that form the surface of the skin, the lining of the hollow organs of the body (such as the bladder and uterus), and the lining of the respiratory and digestive tracts.

How serious is squamous cell carcinoma in situ? ›

Squamous cell carcinoma of the skin is usually not life-threatening, though it can be aggressive. Untreated, squamous cell carcinoma of the skin can grow large or spread to other parts of your body, causing serious complications.

What is the difference between squamous cell carcinoma and squamous cell carcinoma in situ? ›

Squamous cell carcinoma in situ, also called Bowen disease, is the earliest form of squamous cell skin cancer. “In situ” means that the cells of these cancers are still only in the epidermis (the upper layer of the skin) and have not invaded into deeper layers.

What stage is squamous cell carcinoma in situ? ›

Stage 0: Cancer is only in the top layer of your skin (epidermis). This is also called squamous cell carcinoma in situ.

What is treatment for squamous cell carcinoma in situ? ›

Mohs surgery is the most effective technique for removing SCCs, sparing the greatest amount of healthy tissue while achieving the highest possible cure rate – up to 97 percent for tumors treated for the first time.

Is squamous cell carcinoma in situ considered malignant? ›

These in situ cells are not malignant, or cancerous. However, they can sometime become cancerous and spread to other nearby locations. Doctors may also talk about precancerous cells.

How fast does squamous cell carcinoma in situ spread? ›

Squamous cell carcinoma rarely metastasizes (spreads to other areas of the body), and when spreading does occur, it typically happens slowly. Indeed, most squamous cell carcinoma cases are diagnosed before the cancer has progressed beyond the upper layer of skin.

What is the life expectancy of someone with squamous cell carcinoma? ›

In general, the squamous cell carcinoma survival rate is very high—when detected early, the five-year survival rate is 99 percent. Even if squamous cell carcinoma has spread to nearby lymph nodes, the cancer may be effectively treated through a combination of surgery and radiation treatment.

Does squamous cell carcinoma in situ need to be treated? ›

Abstract. Background: Squamous cell carcinoma in situ (SCCIS) is thought to be a precursor to squamous cell carcinoma. It should be treated before invasive cancer develops, especially in transplant recipients, who may develop more aggressive skin cancers. Treatment can involve surgical and nonsurgical methods.

What organs does squamous cell carcinoma affect? ›

If left untreated, squamous cell carcinoma can spread to nearby lymph nodes, bones or distant organs (such as the lungs or liver). Normal squamous tissue usually appears flat. When this tissue develops cancer it can appear as round masses that are can be flat, raised, or ulcerated.

Do you need chemo for squamous cell carcinoma? ›

When squamous cell carcinoma spreads to other parts of the body, drug treatments might be recommended, including: Chemotherapy. Chemotherapy uses powerful drugs to kill cancer cells.

Can you live a long life with squamous cell carcinoma? ›

Most (95% to 98%) of squamous cell carcinomas can be cured if they are treated early. Once squamous cell carcinoma has spread beyond the skin, though, less than half of people live five years, even with aggressive treatment.

What happens if squamous cell carcinoma is left untreated? ›

Like BCCs, SCCs are highly curable when caught and treated early. However, if left to develop without treatment, an SCC can become invasive to skin and tissue beyond the original skin cancer site, causing disfigurement and even death. Over 15,000 Americans die each year from SCCs.

What are the warning signs of squamous cell carcinoma? ›

What are the signs and symptoms of squamous cell carcinoma?
  • Rough, reddish scaly patch.
  • Open sore (often with a raised border)
  • Brown spot that looks like an age spot.
  • Firm, dome-shaped growth.
  • Wart-like growth.
  • Tiny, rhinoceros-shaped horn growing from your skin.
  • Sore developing in an old scar.

Does carcinoma in situ need chemotherapy? ›

Chemotherapy is not needed for DCIS since the disease is noninvasive. Hormonal (endocrine) therapy. Hormonal (endocrine) therapy may be appropriate for those whose ductal carcinoma in situ is hormone receptor positive.

Does squamous cell carcinoma need to be removed? ›

Basal or squamous cell skin cancers may need to be removed with procedures such as electrodessication and curettage, surgical excision, or Mohs surgery, with possible reconstruction of the skin and surrounding tissue. Squamous cell cancer can be aggressive, and our surgeons may need to remove more tissue.

What is the most common cause of squamous cell carcinoma? ›

The cause of most squamous cell carcinoma (SCC) of the skin is well known. People usually develop this skin cancer because ultraviolet (UV) light has badly damaged their skin. Most UV light comes from: The sun.

How do you get rid of squamous cell carcinoma? ›

Squamous Cell Skin Cancer Treatment
  1. Mohs Surgery. Mohs surgery has the highest cure rate of all therapies for squamous cell carcinomas. ...
  2. Curettage and Electrodessication. This very common treatment for squamous cell carcinoma is most effective for low-risk tumors. ...
  3. Cryosurgery. ...
  4. Laser Surgery.

How long does it take to recover from squamous cell carcinoma surgery? ›

The doctor scrapes a little beyond the edge of the cancer to help remove all the cancer cells. The wound is then covered with ointment and a bandage. A scab will form over the area. The wound may take 3 to 6 weeks to heal.

Should situ carcinoma be left untreated? ›

If left untreated, DCIS may develop into invasive breast cancer (cancer that moves beyond the milk ducts). Invasive breast cancer can spread to other parts of your body. Most people with DCIS have no symptoms.

What does early stage squamous cell carcinoma look like? ›

SCCs can appear as thick, rough, scaly patches that may crust or bleed. They can also resemble warts, or open sores that don't completely heal. Sometimes SCCs show up as growths that are raised at the edges with a lower area in the center that may bleed or itch.

Where does squamous cell carcinoma spread first? ›

Hanke: The first place SCCs metastasize to is the regional lymph nodes. So if you have a squamous cell carcinoma on your cheek, for example, it would metastasize to the nodes in the neck. But there are treatments for that. Patients can have surgery, radiation and, in some advanced cases, immunotherapy medication.

What is considered early detection of squamous cell carcinoma? ›

The key warning signs are a new growth, a spot or bump that's getting larger over time, or a sore that doesn't heal within a few weeks. (See Signs and Symptoms of Basal and Squamous Cell Skin Cancer for a more detailed description of what to look for.)

Can squamous cell carcinoma spread to the brain? ›

Squamous cell carcinomas are defined as relatively slow-growing malignant (cancerous) tumors that can spread (metastasize) to surrounding tissue if left untreated. Squamous cell carcinoma may spread to the sinuses or skull base, or other areas of the brain.

Can squamous cell carcinoma be completely cured? ›

Most squamous cell skin cancers are found and treated at an early stage, when they can be removed or destroyed with local treatment methods. Small squamous cell cancers can usually be cured with these treatments.

What is the prognosis of carcinoma in situ? ›

What is the prognosis for people with ductal carcinoma in situ (DCIS)? Because DCIS is contained within a specific area of your breast and hasn't spread, the disease can be controlled and cured with appropriate treatment. After treatment, outcomes are usually excellent. DCIS rarely recurs following treatment.

How long is chemotherapy for squamous cell carcinoma? ›

Applied by a patient at home over the course of approximately three to six weeks.

What happens if squamous cell carcinoma spreads to lymph nodes? ›

When squamous cell cancer spreads to lymph nodes in the neck or around the collarbone, it is called metastatic squamous neck cancer. The doctor will try to find the primary tumor (the cancer that first formed in the body), because treatment for metastatic cancer is the same as treatment for the primary tumor.

Should you see an oncologist for squamous cell carcinoma? ›

Most basal and squamous cell cancers (as well as pre-cancers) are treated by dermatologists – doctors who specialize in treating skin diseases. If the cancer is more advanced, you may be treated by another type of doctor, such as: A surgical oncologist: a doctor who treats cancer with surgery.

How many stages does squamous cell carcinoma have? ›

The 5 Stages of Squamous Cell Skin Cancer

This gives doctors greater opportunities to treat the cancer early, which may be final and curative.

What kind of biopsy is done for squamous cell carcinoma? ›

Squamous cell carcinomas arise from keratotic patches and become more nodular and erythematous with growth, sometimes including keratin plugs, horns, or ulceration. Because they may metastasize, they often are treated with excisional biopsy.

Is squamous cell carcinoma precancerous? ›

Some precancerous skin growths go on to become a type of skin cancer called squamous cell carcinoma. There's no way for your dermatologist to know which ones will progress to skin cancer. When you get rid of an AK, it cannot go on to become skin cancer. Treatment can relieve symptoms, such as itching or tenderness.

What are high risk features of squamous cell carcinoma? ›

High-risk features are depth of invasion (>2 mm), poor histological differentiation, high-risk anatomic location (face, ear, pre/post auricular, genitalia, hands, and feet), perineural involvement, recurrence, multiple cSCC tumors, and immunosuppression.

What are the side effects of squamous cell carcinoma? ›

Squamous Cell Carcinoma Symptoms
  • A dome-shaped bump that looks like a wart.
  • A red, scaly patch of skin that's rough and crusty and bleeds easily.
  • An open sore that doesn't heal completely.
  • A growth with raised edges and a lower area in the middle that might bleed or itch.
26 Apr 2022

Does squamous cell carcinoma cause fatigue? ›

Squamous cell carcinoma of the lung can also cause symptoms common to other cancers in general, such as: Fatigue (extreme tiredness) Not feeling hungry. Weight loss.

What foods fight squamous cell carcinoma? ›

Food That Lower Your Skin Cancer Risk

Vitamin C – Citrus fruits, strawberries, raspberries, broccoli, bell peppers, and leafy greens. Vitamin D and Omega-3 fatty acids – Fatty fish, like mackerel, sardines, herring, tuna, and salmon. Vitamin D – Milk, cheese, and vitamin D-fortified orange juice.

Which squamous cell carcinoma has best prognosis? ›

Patients with stage I, II, or III cancer have the best survival, whereas patients with stage IV or recurrent cancer who are older than 66.5 years have the worst survival. Patients with stage IV or recurrent cancer who are younger than 66.5 years have intermediate survival.

What drugs are used to treat squamous cell carcinoma? ›

Drugs Approved for Cutaneous Squamous Cell Carcinoma
  • Cemiplimab-rwlc.
  • Keytruda (Pembrolizumab)
  • Libtayo (Cemiplimab-rwlc)
  • Pembrolizumab.
20 Apr 2022

What is the most common treatment for squamous cell carcinoma? ›

Mohs surgery is the most effective technique for removing early SCCs and is also used for SCC tumors that have recurred, are large or growing rapidly or have indistinct edges.

Can squamous cell carcinoma spread to bone? ›

Abstract. Squamous cell carcinoma (SCC) is the second most common non-melanoma skin cancer worldwide and one of the most capable of metastasis. The bone is a common metastatic site of cancers, which is a major cause of morbidity, with an estimated 350,000 people dying yearly from bone metastases.

Can squamous cell carcinoma spread to the lungs? ›

Squamous cell carcinoma often spreads (metastasizes) to other parts of the body because of the constant flow of fluids (blood and lymph) through the lungs.

How do you know if squamous cell carcinoma has spread beyond the skin? ›

Ask your doctor if your lymph nodes will be tested. Basal and squamous cell cancers don't often spread to other parts of the body. But if your doctor thinks your skin cancer might spread, you might need imaging tests, such as MRI or CT scans.

What does Stage 4 squamous cell carcinoma look like? ›

Symptoms of stage 4 squamous cell carcinoma usually begin with some kind of skin lesion or growth. Often, the tumors of squamous cell carcinoma look like a scaly red patch of skin that won't heal. These tumors are often crusty and raised, and they may cause sores or ulcers that last for several weeks.

How long can you live with Stage 4 squamous cell carcinoma? ›

The prognosis of patients with recurrent or metastatic head and neck squamous cell cancer is generally poor. The median survival in most series is 6 to 15 months depending on patient- and disease-related factors.

How does squamous cell carcinoma make you feel? ›

Symptoms of squamous cell carcinoma include skin changes like: A rough-feeling, bump or growth, which might crust over like a scab and bleed. A growth that's higher than the skin around it but sinks down (depression) in the middle. A wound or sore that won't heal, or a sore that heals and then comes back.

Is squamous cell carcinoma ever fatal? ›

Cutaneous squamous cell carcinoma is usually easily treated with surgery; however, a subsection of patients with specific disease risk factors are more likely to develop metastases and die from the disease, according to the results of a study published in JAMA Dermatology.

What is squamous cell carcinoma in situ? ›

Squamous cell carcinoma in situ, also called Bowen disease, is the earliest form of squamous cell skin cancer. “In situ” means that the cells of these cancers are still only in the epidermis (the upper layer of the skin) and have not invaded into deeper layers.

How serious is Bowen's disease? ›

The patch is usually very slow-growing. But there's a small chance it could turn into a more serious type of skin cancer if left untreated. Bowen's disease itself isn't usually serious. It tends to grow very slowly over months or years.

Is Bowen's disease benign or malignant? ›

Bowen's disease is a cancerous condition. It involves scaly patches that can turn into skin cancer over time. The most common cause is prolonged sun exposure, but HPV infections, arsenic exposure, and a compromised immune system can also play a role.

What is the best treatment for Bowen's disease? ›

Bowen disease (squamous cell carcinoma in situ) is usually treated by excision (cutting out the tumor). Mohs surgery, curettage and electrodesiccation, radiation therapy, topical fluorouracil (5-FU), and cryosurgery are other options. Laser surgery or other topical therapies may be considered in special situations.

Does Bowen's disease ever go away? ›

The diagnosis may also be confirmed by taking a sample of skin (also known as a biopsy) and examining it under a microscope. Bowen's disease can be cured with a variety of treatments, including freezing, scraping, surgical removal or a special cream.

Can Bowen disease be cured? ›

There are many ways to treat Bowen's disease. Because it is such an early cancer, it can very likely be cured. The best type of treatment for you will depend on the size and thickness of the Bowen's disease, where it is on your body, your age and health, and your preference.

How long can you live with squamous cell? ›

In general, the squamous cell carcinoma survival rate is very high—when detected early, the five-year survival rate is 99 percent. Even if squamous cell carcinoma has spread to nearby lymph nodes, the cancer may be effectively treated through a combination of surgery and radiation treatment.

Is Bowen's disease painful? ›

Bowen disease only affects the outermost layer of the skin (epidermis). Lesions are usually not painful or may not be associated with any symptoms (asymptomatic). In most cases, treatment is highly successful.

Can Bowen's disease appear suddenly? ›

A patch of Bowen's disease can appear for no apparent reason and can affect anyone. However, there are a number of different things that are thought to increase your risk of developing Bowen's disease. These include: Long-term sun exposure.

What is the difference between benign tumor and carcinoma in situ? ›

These growths remain benign but contain abnormal cells that have the potential to become cancerous in the future. One example of a pre-malignant tumor is known as carcinoma in situ. This is where abnormal cells are formed but have remained in place and not yet spread.

What is the difference between Bowen's disease and squamous cell carcinoma? ›

Bowen's disease is sometimes called squamous cell carcinoma in situ. If it is not treated, it can occasionally develop into squamous cell carcinoma (SCC). This happens in a small number of people (about 3 to 5 out of every 100 who have Bowen's disease). SCC is a common, curable type of skin cancer.

What kills squamous cell carcinoma? ›

Chemotherapy. Chemotherapy uses powerful drugs to kill cancer cells. If squamous cell carcinoma spreads to the lymph nodes or other parts of the body, chemotherapy can be used alone or in combination with other treatments, such as targeted drug therapy and radiation therapy.


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Phone: +9958384818317

Job: IT Representative

Hobby: Scrapbooking, Hiking, Hunting, Kite flying, Blacksmithing, Video gaming, Foraging

Introduction: My name is Jamar Nader, I am a fine, shiny, colorful, bright, nice, perfect, curious person who loves writing and wants to share my knowledge and understanding with you.