Bowen's disease (BD) is an incipient squamous cell carcinoma (SCC) that is still localized to the epidermis. Protheragen offers comprehensive Bowen's Disease (BD) diagnostic and therapeutic development services. For BD, we provide complete and comprehensive solutions from initial research to preclinical validation, which include target identification, assay design, model creation, and therapeutic assessment.
Overview of Bowen's Disease (BD)
Bowen's disease (BD) or squamous cell carcinoma in situ is a precancerous disease marked by atypical squamous cells that are restricted to the epidermis. BD is usually seen as a slowly progressive, raised red patch or plaque that is scaly in nature and is well-defined. It is mainly located on sun-exposed parts of the body, lower limbs, and the head and neck region. It is more common among caucasoid population with an incidence of roughly 1.42 per 1000 persons. BD is primarily seen in the old age population and is more common in females with a slight predominance. The chances of developing into an invasive squamous cell carcinoma are rather low. Extragenital lesions have a 3-5% chance, while genital lesions may increase this risk to 10%.
Fig.1 Etiopathogenesis model of Bowen's disease. (Palaniappan V.,
et al., 2022)
Diagnostics Development for Bowen's Disease (BD)
- Histopathology: Histopathology continues to be the most reliable method for diagnosing BD. The hallmark features are hyperkeratosis, parakeratosis, marked acanthosis, along with full-thickness atypical changes of the epidermis, which do not extend beyond the dermo-epidermal junction. Diagnosis is also confirmed with the presence of some dyskeratotic cells as well as multinucleated giant cells.
- Dermoscopy: While there are no set criteria for BD in dermoscopy, it can show signs like scaly surface, small brown globules, and reticular pigmentation. These findings can aid in the clinical suspicion of BD, guiding further histopathological confirmation.
- Immunohistochemistry: The distinction of BD from other diseases is aided by IHC staining. As an example, p16 overexpression signals abnormalities in the cell cycle, in addition to which atypical keratinocytes will stain with Ki-67. BD may also be differentiated from actinic keratosis by lumican staining.
- Reflectance Confocal Microscopy: Reflectance confocal microscopy is an imaging technique that is non-invasive and can differentiate pigmented BD from other pigmented lesions. It detects the polygonal, refractile structures and atypical keratinocytes, which assist histopathology.
Therapeutics Development for Bowen's Disease (BD)
- Imiquimod: Imiquimod is an immune response modifier because it stimulates the production of local cytokines. It works on BD lesions both on the lower leg as well as on the shaft and glans of the penis with a clinical efficacy of 57-86%. Therapeutic consists of daily applications for 16 weeks, and side effects like erythema and inflammation can occur.
- 5-Fluorouracil (5-FU): 5-FU serves as a cytotoxic medication for BD lesions located on the shaft of the penis and the skin. Administered once or twice per day for a period of 3-4 weeks, it attains clearance rates of almost 83 percent. The use of 5-FU with other techniques like occlusive application or iontophoresis increases overall effectiveness.
- Diclofenac: Diclofenac, an NSAID, works by inhibiting the cyclooxygenase enzymes. Some patients with BD have responded to it with complete clinical and histological resolution, which is quite remarkable. Therapeutic involves a bid application for 8-12 weeks. Side effects are mild and include inflammation as well as dryness.
Table 1. Summary of various therapeutic modalities of Bowen's disease. (Palaniappan V., et al., 2022)
| Drug |
Application |
Preferred |
Limitations and Adverse Effects |
Outcome |
| Imiquimod 5% cream |
Once daily application for 16 weeks |
Large lesions, face, lower leg, shaft of penis, glans penis |
Limited response in hyperkeratotic lesions, erythema, inflammation, crusting, pigmentation |
57%-86% clearance |
| 5-Fluorouracil cream |
Once or twice-daily application for 3-4 weeks, repeated if required |
Large lesions, poor healing sites |
Cannot be used in immunocompromised patients, pain, erythema, burning sensation, ulceration |
48%-83% clearance |
| Cryotherapy |
Freeze for 30 s at least once or 20 s at least twice for one to three sittings |
Good healing sites, Multiple lesions |
Cannot be used in poor wound healing sites, Hypopigmentation, scarring |
68%-100% clearance 5%-10% failure rate |
| Curettage with cautery |
Simple, single-time, safe method |
Small/single lesion, facial lesions |
It cannot be performed for larger lesions. Success depends on the skills of the operator |
93%-98% cure rate 2%-20% recurrence |
| Excision |
Simple, wide excision of the lesion |
Small/single lesion with poor healing |
Prolonged wound healing, poor functional and cosmetic outcomes |
2.8% to 19.4% recurrence |
| Moh's micrographic surgery |
Individual layers of tissue are removed and examined under a microscope |
Tissue sparing sites such as the periorificial, genital, and perianal regions |
Expensive, needs a skilled operator |
Recurrence is around 6.3% |
| Photodynamic therapy |
Day 0, 7, and repeated after 1 month |
For larger lesions and difficult-to-treat areas |
Pain |
88%-100% clearance 3 months after one cycle of MAL-PDT |
| Radiotherapy |
Both high- and low-dose regimens are equally efficacious |
Difficult-to-treat sites such as the digits and the penis |
High cost, patient inconvenience, poor healing, erythema, edema |
Failure to heal in 33% of individuals |
Disclaimer: Protheragen focuses on providing preclinical research services. This table is for information exchange purposes only. This table is not a treatment plan recommendation. For guidance on treatment options, please visit a regular hospital.
Our Services
Protheragen provides a comprehensive range of services designed to advance the development of diagnostics and therapeutics for Bowen's Disease (BD). Our offerings cover all stages of the process, from early target discovery to preclinical validation. We specialize in histopathological, molecular, and imaging diagnostics, along with a variety of therapeutic approaches, including topical, systemic, and immunotherapies. By utilizing state-of-the-art technologies and a multidisciplinary strategy, we aim to expedite the translation of groundbreaking scientific insights into effective clinical solutions.
Disease Models
- p53 Gene Mutation Mouse Models
- Rat Surgical Models
- Carcinogenic Chemical-Induced Guinea Pig Models
- Non-Human Primate Models
Protheragen understands that every research project has distinct needs, which is why we offer tailored services designed to meet specific goals. Whether developing a novel diagnostic biomarker or optimizing a therapeutic regimen, our team works closely with clients to design and execute studies that align with their precise objectives. Our adaptable approach allows us to respond to evolving research challenges and leverage the latest technological advancements. If you are interested in our services, please feel free to contact us.
References
- Palaniappan, Vijayasankar, and Kaliaperumal Karthikeyan. "Bowen's disease." Indian dermatology online journal 13.2 (2022): 177-189.
- Neubert, Thorsten, and Percy Lehmann. "Bowen's disease–a review of newer treatment options." Therapeutics and Clinical Risk Management 4.5 (2008): 1085-1095.
All of our services and products are intended for preclinical research use only and cannot be used to diagnose, treat or manage patients.
