Bowen’s disease is a localized intraepidermal squamous cell carcinoma of the skin that may progress into invasive carcinoma over many years. Bowen’s disease also occurs on the male and female genital mucosae and (rarely) in the oral mucosa as an erythroplakic, leukoplakic, or papillomatous lesion.
Bowen’s disease occurs most commonly on the skin, as a result of arsenic ingestion. It grows slowly as an enlarging erythematous patch, with little to suggest a malignant process. The histologic picture is very characteristic, with the epithelium exhibiting a significant loss of cellular polarity and orientation, increased and abnormal mitoses, multiple highly atypical hyperchromatic nuclei, and cellular pleomorphism. Individual cell keratinization at different levels of the epithelium is seen. Lesions of this type are often associated with visceral cancer.
Because of the clinical and histologic similarity between Bowen’s disease and erythroplakia (both of which can be characterized as red patches of the mucous membrane that histologically contain severely dysplastic epithelium or intraepithelial carcinoma), the question has been raised as to whether they are the same disorder.Current opinion, based on the comparison of oral erythroplakias with the oral lesions of Bowen’s disease, holds that they are separate disorders.
A nodular, benign, and virus-associated epithelial dysplasia with a histologic picture resembling Bowen’s disease (bowenoid papulosis) occurs on the genital mucosa of sexually active young adults and has been reported on multiple oral mucosal surfaces on rare occasions.