How to Diagnose Bowen's Disease

Bowen's disease is a type of skin cancer characterized by slow growing brown or pink papules covered by a thick horny layer. It is thought to be primarily caused by exposure to the sun, although arsenic ingestion and the human papilloma virus (HPV) also are known causes. Bowen's disease is probably caused by other factors and the source is frequently undetermined. The following steps will show how to diagnose Bowen's disease.

Instructions

1. Complete an examination of the entire skin. Check for lesions on sun-exposed skin. Bowen's disease usually produces a single lesion with a sharply demarcated irregular border. They may be pigmented on rare occasions, especially in the genital region and nails.

2. Study the patient's history for exposure to the sun. It also may be prudent to test for the presence of HPV 16 and measure the patient's arsenic level.

3. Take a skin biopsy and include follicular structures. This is typically done in the doctor's under local anesthesia.

4. Have the biopsy examined by a dermatopathologist to determine its histological characteristics. A general examination of skin cells affected by Bowen's disease should show a full-thickness anaplasia with a windblown appearance. It produces atypical and disorderly keratinocytes which extend down the follicular epithelium although the basal cell layer remains intact.

5. Conduct a detailed microscopic examination of the skin biopsy. Bowen's disease should produce a moderate lymphocytic infiltrate in the upper dermis with individually keratinizing cells, mitoses, multinucleated cells and vacuolization in the epidermis. Often, large pale keratinocytes with ground glass cytoplasm cells will be distributed haphazardly in the epidermis.