John T. Bowen

John Templeton Bowen (1857 - 1940)

John Templeton Bowen (1857 – 1940) was an American dermatologist.

Pioneer of dermatopathology and first professor of dermatology at Harvard Medical School.

Most famous for his description of ‘precancerous dermatoses’ published in the Journal of Cutaneous Diseases in 1912. Eponymously associated with carinoma in situ or intraepithelial neoplasia of sun exposed skin (Bowen’s disease); vulva (Bowen’s disease of the vulva); and penis (Bowenoid papulosis and Bowen’s disease of the penis)


Biography
  • Born on July 8, 1857 in Boston
  • 1869–1875 – Studied at America’s oldest school, the Boston Latin School
  • 1879 – BA, Harvard College
  • 1884 – MD, Harvard Medical School
  • 1884-1887 – Post-graduate dermatology training in Berlin, Munich and Vienna
  • 1889 – Assistant physician for Diseases of the Skin to the Massachusetts General Hospital serving the Harvard Medical School. Full physician in 1895
  • 1896 – Instructor in dermatology, Harvard Medical School
  • 1907 – First Edward Wigglesworth Professor of Dermatology of the Harvard University
  • 1912 – Emeritus Professor of Dermatology
  • Died on December 3, 1940

Medical Eponyms
Bowen’s disease (1912)

Bowen’s disease is an intra-epidermal squamous cell carcinoma or squamous cell carcinoma in situ.  It occurs when a collection of squamous cells in the outer skin layer (epidermis) become cancerous. They appear as red scaly patches on the skin surface. They are typically slow-growing but if left untreated may progress to invasive squamous cell carcinoma. It most commonly affects sun exposed areas of skin.

1912 Bowen first described the disease, that later became named after him. He reported two cases, both males in their 50’s with skin eruptions described as ‘chronic atypical epithelial proliferation’.

The lesions were circumscribed; in the one case limited to the left gluteal region, in the other to the calf of the right leg. They appeared as papular and tubercular lesions, only slightly elevated above the normal skin, of a moderately firm consistency, and dull red in color. The surface was in some places slightly crusted; in other places it had a papillomatous character. The lesions were in places confluent, forming areas of tumor-like masses; in other places, especially at the edge of the affected areas, they were discrete, or assumed annular or serpiginous figures.

As yet no signs of malignancy have appeared in these cases. It can hardly be doubted that such a sequel is imminent.

Bowen, 1912
Bowen's disease Precancerous Dermatosis of Bowen 1912 Case 1


Bowen. Case 1 (Fig 103) In: Precancerous Dermatoses. 1912
Fig. 1. As it appeared in October, 1911. The cicatricial portions mark the site of lesions previously removed.
Fig. 2. Low power shows hyperkeratosis, proliferation and thickening of rete, vacuolization and abnormal cornification of cells; dilatation of vessels of corium, with cell masses surrounding them.
Fig. 3. High power. Shows peculiar “clumping” of nuclei and karyokinesis

1914 The subject was greatly elaborated and clarified by Ferdinand-Jean Darier (1856-1938) in an article in the Annales de dermatologie et de syphiligraphie titled la dermatose précancéreuse de Bowen, dyskératose lenticulaire et en disques in which is embodied the description of a further three typical examples of the same affection.

1915 Bowen followed up his original contribution reviewing his first two cases; then the three cases of Darier and Danel; and finally adding a third case of his – the sixth case to be reviewed. Bowen’s final review was published in Archives of Dermatology in 1920

1918 Darier included the disease in his Textbook of Dermatology as ‘Dyskeratosis of Bowen’. He included a photograph of the skin lesion he had seen on the ankle of a 39-year-old female.

Dermatose précancéreuse de Bowen ou dyskératose lenticulaire et en disques. – J’ai proposé d’attacher le nom de J.T. Bowen à une dermatose essentiellement chronique et progressive, qu’il a le premier décrite en 1912. Elle se présente sous forme de disques lenticulaires ou nummulaires (Fig 77), puis de placards de forme irrégulére, surmontés d’épaisses squames-croûtes; les éléments généralement multiples, non symétriques, peuvent siéger n’importe où. On peut rencontrer aussi des taches atrophiques, d’apparence pagetoide.

Darier 1918 (French 2e)

Precancerous Dermatosis of Bowen or Dyskeratosis Lenticularis et Discoides. – I have recommended that the name of J. T. Bowen be attached to an essentially chronic and progressive dermatosis first described by him in 1912. It appears in the form of lenticular or nummular disks (Fig. 80), later patches of irregular shape, covered with thick scaly crusts; the lesions are generally multiple, non-symmetrical, and may be situated anywhere. Atrophic spots, resembling Paget’s disease, may also be seen.

Darier 1920 (English translation of French 2e)

Bowen's disease cited by Darier 1914
Fig. 80: Dyskeratosis of Bowen, showing a patch composed of lenticular and discoid lesions on the internal malleolus of a woman, aged thirty-nine years. Personal observation, 1914 [Darier 1920]

Bowen’s disease of the vulva [aka vulvar intraepithelial neoplasia ]

Bowen’s disease is regarded as a squamous-cell carcinoma in situ, and can develop on any part of the skin surfaces or mucous membranes. The majority are cases occur on sun-exposed surfaces such as the head, neck, and hands. Lesions on the vulva are less common.

In 1943, Richard van Dyck Knight reviewed the literature on Bowen’s disease of the vulva, traced reports of 26 cases, and added 6 new ones. He concluded that Bowen’s disease was

…a specific entity, namely, a superficial, noninvasive intraepithelial epithelioma characterized by (a) Chronicity, pruritus and a characteristic gross and microscopic appearance and (b) Malignant tendencies when involving mucosal surfaces.

Knight, 1943

Subsequent evaluation confirmed the characteristics of Bowen’s disease as epidermal hyperplasia; parakeratosis; mitotic figures (especially in the upper 1/2 to 1/3 of the epidermis); and atypical keratinocytes with large hyperchromatic, pleomorphic nuclei and multinucleated keratinocytes.

Human papillomavirus (HPV) type 16 and related types are frequently found in genital located Bowen’s disease and only rarely identified in non-genital cutaneous Bowen’s disease and squamous cell cancer (SCC). In 1983, Ikenberg et al found that HPV 16 DNA or related sequences were identified in 60% of cases of Bowen’s disease (80% in cases of genital localization); and in 80% biopsies from Bowenoid papulosis.

…these data reveal a striking association of HPV 16 infections with both types of lesion which are generally regarded as precancerous conditions…the very specific presence of HPV 16 DNA in Bowen’s disease and Bowenoid papulosis and in human genital cancer of three different sites (cervical, vulva and penile) points to some role of these infections in the induction of these proliferative changes.

Ikenberg et al, 1983

In 1987 the term was “deleted from the vocabulary of vulvar diseases” by gynecopathologists and was substituted by the non-specific designation “vulvar intraepithelial neoplasia” 

Bowenoid papulosis

Bowenoid papulosis is a sexually transmitted condition occuring in both males and females that presents as pigmented genital papules due to human papillomavirus (HPV) infection, particularly HPV 16. Now more commonly termed vulvar or penile squamous intraepithelial lesion or High grade squamous intraepithelial lesion (HSIL).

HSIL is a squamous cell abnormality associated with human papillomavirus (HPV) and encompasses the entities previously termed cervical intraepithelial neoplasia (CIN), and carcinoma in situ. HSIL has the potential to become invasive squamous cell carcinoma.

In 1977, Kopf and Bart described Bowenoid papules of the penis as a potential new clinical entity. They presented a case of a young man with multiple papules on the shaft and glans of his penis. Histology showed many discrete lesions of squamous cell carcinoma in situ (Bowen’s disease) concentrated in a small area.

Bowenoid papulosis 1977 Kopf Bart
Fig 2. The lesions show histologic features of acanthosis and atypical keratinocytic hyperplasia. There are dyskeratotic cells in disorderly arrangement throughout the epidermis. The interpretation is squamous-cell carcinoma in situ (Bowen’s disease). Kopf AW, Bart RS. 1977

1978, Wade et al studied 36 biopsy specimens from 11 men aged 21-36 years presenting with multiple red-violaceous papules, some distinctly verrucoid or velvety on either or both the shaft and glans of the penis. The clinical diagnoses accompanying the biopsy specimens included lichen planus, psoriasis and condyloma acuminatum. In no instance was carcinomia in situ suggested in the differential diagnosis. Histologically, however, all specimens submitted showed indubitable changes of squamous cell carcinoma in situ. Bowenoid papulosis (BP)shares the histological features of Bowen’s disease of the penis (BPD) but is distinguished from the latter by clinical differences

1) onset at a much earlier age (average age of 28), 2) multiple simultaneous lesions in all patients, 3) localization primarily on the shaft rather than the glans of the penis, 4) lack of symptoms, 5) smaller size (2 mm to 10 mm), 6) papules rather than plaques, and 7) verrucoid nature of some lesions

Wade, 1978

Note: There is confusion in nomenclature of three clinical variants of carcinoma in situ of the penis. Histopathologically, these conditions share similar histologic features of squamous cell carcinoma in situ, but the clinical features and presentations differ. 

  1. Bowenoid papulosis (BP): Multiple wart-like lesions, often pigmented in keratinized sites, and more numerous and more inflamed at ‘mucosal’ sites. The lesions are smoother (less papillomatous), polymorphic and more coalescent than common genital viral warts (condylomata acuminata). They occur in young, sexually active men
  2. Bowen’s disease of the penis (BDP): Red or hyperpigmented scaly patches and plaques of the keratinised penis often with a warty or crusty appearance. More common in older males.
  3. Erythroplasia of Queyrat (EQ): Single or multiple, non-tender, shiny red patches or plaques of the ‘mucosal’ penis. More common in older males. Originally described and drawn by Auguste Queyrat in 1911

Major Publications

References

Biography

Eponymous terms

Bowen’s disease

Bowen’s disease of vulva

Bowenoid papulosis


eponymictionary CTA

eponym

the person behind the name

Welsh junior doctor graduated from Cardiff Medical School with MBBCh and BSc in Medical Education. Currently working in emergency medicine in Perth, Australia. Aim to commence GP training in the UK in 2022.

Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM with a passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | Twitter |

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