Bowen's Disease as a Predictor of Malignancy

To the Editor.—  In response to the article by Arbesman and Ransohoff¹ in the Jan 23/30,1987, issue of JAMA, I would like to suggest a different approach to the problem of using Bowen's disease as a predictor of internal malignancy. Rather than attempting to pair Bowen's disease with future occurrences of all types of internal malignancy, more valid associations might be developed by pairing Bowen's disease with a specific internal malignancy. Cowden's disease, which includes multiple tricholemmomas among its physical signs, is associated with a high incidence of breast cancer.² Skin tags have been shown to serve as cutaneous markers for adenomatous polyps of the colon.³ Bowen's disease may be associated with a particular internal malignancy in a highly predictive manner. The data generated over the past generation may not be totally useless, as the authors are suggesting, and could be reanalyzed, pairing Bowen's disease with the