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A Population-Based Cohort Study of 1147 Patients

Ane Bonnerup Jæger; Anne Gramkow, MD; Henrik Hjalgrim, MD; Mads Melbye, MD, PhD; Morten Frisch, MD, PhD

Arch Dermatol. 1999;135:790-793.

Objective  To address the long-standing question of whether patients with Bowen disease are at increased risk of internal malignant neoplasms.

Patients  A total of 1147 Danish patients diagnosed between 1978 and 1993 as having Bowen disease at nongenital sites were followed up for 6463 person-years for cancer occurrence up to 16 years after the skin lesion.

Main Outcome Measure  Standardized incidence ratios (SIRs)—the ratios of observed-to-expected numbers of cancer—served as measures of relative risk.

Results  The observed number of noncutaneous cancers occurring in the cohort (n=115) was close to expected (n=103.0) (SIR=1.1; 95% confidence interval, [CI], 0.9-1.3). However, nonmelanoma skin cancer (SIR=4.3; 95% CI, 3.5-5.4; n=83), lip cancer (SIR=8.2; 95% CI, 2.6-19.1; n=5), and, among men, leukemia (SIR=3.2; 95% CI, 1.04-7.5; n=5) occurred in excess.

Conclusions  Patients with Bowen disease do not appear to constitutionally be at any unusually high general cancer risk. The increased risk of invasive skin and lip cancers is likely due to the common risk factor of UV light.

From the Department of Epidemiology Research, Danish Epidemiology Science Center, Statens Serum Institut, Copenhagen, Denmark.

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