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Bowen's Disease and Internal Cancer

Irwin M. Braverman, MD
JAMA. 1991;266(6):842-843. doi:10.1001/jama.1991.03470060104037.
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In 1959 and 1961, Graham and Helwig1,2 reported an unexpected association: Bowen's disease of the skin (epidermoid carcinoma in situ) was followed, after a variable latent period of 1.3 to 13 years, by the eventual development of internal cancer in 48% of affected individuals. The cancers involved all three germ layers and included lymphomas and leukemias. Multiple reports by others supporting these observations followed immediately,3-5 and the concept that Bowen's disease was a high-risk factor for the future development of cancer, especially if it occurred on a part of the body not exposed to the sun, became an established fact in textbooks. In the past decade, however, these findings have not been confirmed,6-8 and the validity of the observation has been questioned because of errors in the methods of data acquisition.6,9,10 The earlier studies have been criticized because of lack of appropriate


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