I. Translation: Bowen’s disease
II. Aliases.
1.Carcinoma in situ of the skin;
2.Intraepithelial epithelial tumor;
3, intraepithelial epithelial cell tumor;
4.Epidermoid carcinoma in situ;
5.Endothelial epidermis-like carcinoma;
6.Pre-cancerous skin disease;
7, precancerous dermatitis.
Summary: In 1912, Bowen, an American dermatologist, first reported this disease and named it Bowen’s disease; subsequent reports were based on skin lesions, and in 1952, Mc Gavic first reported this disease from an ophthalmic viewpoint. In China, a case was reported by Du Nianzu in 1957. The main feature is the appearance of hard, slightly elevated reddish papule-like material on the skin, which can become malignant after several years.
Some people believe that the changes in exposed areas may be induced by sun exposure, while lesions in non-exposed areas are probably related to the internal administration of arsenic, and the increased extra-skin arsenic content also suggests the carcinogenic effect of arsenic, and some people believe that it is related to chronic inflammatory infections. Pathological examination shows atypical squamous cell hyperplasia throughout the epidermis with columnar angular downward growth, but the basement membrane remains intact, the nuclei are deeply stained and often divided, and lymphocyte and plasma cell infiltration is seen in the superficial dermis.
V. Ocular features.
The lesions can invade the eyelids, conjunctiva or cornea, mostly at the angular scleral margin and the conjunctiva at the lid margin, which appear as gray-red or gray-white granulation tissue-like elevations, covered with pine-needle-like neovascularization like papillary growth, closely connected to the tissue below.
2. The conjunctiva may form nodules or ulcers. The cornea may have superficial inflammatory clouding and corneal vascular proliferation.
VI. Systemic features.
1, the disease occurs in exposed areas of the skin and mucous membranes, can also occur in other areas, no conscious symptoms, or only mild pain, initially as a light red or dark red papule, some scales or scabs on the surface, slowly expanding into a hard with white scales, difficult to separate, slightly elevated, no infiltration, clear edges. Few of them may become squamous cell carcinoma.
2.The disease process progresses slowly, and within 5-10 years after diagnosis, some patients develop visceral cancer. If it occurs in glans, it is also called proliferative erythema.
3.Skin biopsy can help to diagnose. The pathological return also has important features: large cell ribs, dense staining, eosinophilic cytoplasm, intact basement membrane, and incomplete keratinized cells on the tumor surface.
Differential diagnosis: It has been misdiagnosed as recurrent pterygium with active conjunctival epithelial hyperplasia.
VIII. Treatment: Surgical excision is the best approach. Cryotherapy, cobalt and x-ray irradiation, etc., may also be applied. Occurrence in the eyelid skin can be treated with 2.5% 5-fluorouracil ointment applied topically. 25% show primary cancer within 5 years.