These guidelines for management of Bowen's disease have been prepared for dermatologists on behalf of the British Association of Dermatologists. They present evidence-based guidance for treatment, with identification of the strength of evidence available at the time of preparation of the guidelines, and a brief overview of epidemiological aspects, diagnosis and investigation.

https://www.bad.org.uk/library-media/documents/Bowens%20disease%201999.pdf

Guidelines for management of Bowen's disease

This article represents a planned regular updating of the previous British Association of Dermatologists (BAD) guidelines for management of Bowen’s disease. They have been prepared for dermatologists on behalf of the BAD. They present evidence-based guidance for treatment, with identification of the strength of evidence available at the time of preparation of the guidelines.

Guidelines for management of Bowen's disease: 2006

background Actinic keratosis (AK) is a common sun-induced precancerous neoplasm confined to the epidermis. It is the initial manifestation of a continuum of clinical and histologic abnormalities that progresses to invasive squamous cell carcinoma (SCO, a disorder that accounts for thousands of preventable deaths in America each year.



objective The purpose of this work is to describe the actinic keratosis.



methods This effort was performed by a literature review and analysis.



results Like SCCs, the vast majority of AKs are asymptomatic. Although some actinic keratoses may become clinically inapparent, possibly cither due to immune rejection or simply having their external surface unknowingly scraped off, an untreated AK represents a potentially curable fatal cancer.



conclusions Each AK should be treated before it progresses to invasive squamous cell carcinoma. Destructive modalities such as cryosurgery using liquid nitrogen and electrodesiccation and curettage are the mainstays of therapy. Each case must be individualized.



learning objectives After studying this article, participant should be able to:



1
Understand the concept of an actinic keratosis.

2
Learn how to recognize its clinical manifestations.

3
Be aware of the danger it poses as an easily curable papulonodule that may become a fatal cancer.

The actinic keratosis. A perspective and update.

Tumors of surface epithelium.

Computer-assisted image analysis is useful for quantifying the histologic and molecular changes of sun-induced squamous cell carcinoma progression. We used the CAS 200 image analysis system to measure nuclear morphometric parameters, p53 expression, and proliferation markers in actinic keratosis (AK), sun-exposed, and normal skin in 51 patients. Nuclear morphometry revealed significant increases in nuclear absorbance, irregularity of nuclear shape, and nuclear size in AK compared with normal and sun-damaged skin. These parameters showed significantly greater variability in AK nuclei. Argyrophyllic nucleolar organizer area and number were also significantly greater in AK compared with sun-damaged skin and normal skin. Ki67 and p53 expressions were both increased in sun-damaged skin relative to normal and greater still in AK. These data are evidence that sun damage induces proliferation and p53 abnormalities before the appearance of nuclear abnormalities and their associated DNA instability. Following these changes during a skin cancer chemopreventative trial can then help assess the efficacy of the agent and help determine where in the progression of neoplastic changes it exerts its biological effects.

/pdf/nuclear-morphometry-and-molecular-biomarkers-of-actinic-1ejv3w9t32.pdf

Nuclear Morphometry and Molecular Biomarkers of Actinic Keratosis, Sun-Damaged, and Nonexposed Skin

The value of DNA single cell cytometry for the detection of aneuploidy was assessed in 100 specimens of actinic keratoses and 39 specimens of Bowen's disease. Ten seborrhoeic keratoses and 10 samples of normal epidermis served as negative control groups. Monolayer smears, prepared from formalin-fixed, paraffin-embedded tissues, were Feulgen-stained and used for interactive DNA-cytometry. In each specimen, the DNA content of 150 randomly chosen squamous epithelial cells was measured, using a TV-image analysis system (TAS-plus, Leica, Germany). Aneuploidy was diagnosed if at least three nuclei with a DNA content above 5c (5cEE > or = 3) were found. The aneuploidy rate in actinic keratosis was 69% (69 of 100) and in Bowen's disease was 95% (37 of 39). Another 20 specimens of actinic keratoses and the remaining two specimens of Bowen's disease were diagnosed as suspicious for aneuploidy (0 < 5cEE < 3). The 20 specimens of seborrhoeic keratoses and normal epidermis did not show any nuclei above the 5c level, and were classified as non-aneuploid. This indicates a sensitivity of 76% (106 of 139) and a specificity of 100% (20 of 20). The frequent occurrence of aneuploidy in actinic keratoses and Bowen's disease underlines the character of the lesions as epidermal carcinomas in situ, but does not explain the long-term low incidence of invasive growth.

Aneuploidy in actinic keratosis and Bowen's disease—increased risk for invasive squamous cell carcinoma?

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Aneuploidy in actinic keratosis and Bowen's disease—increased risk for invasive squamous cell carcinoma?