Is Bowen's disease a predictor for the development of internal malignancy? A methodological critique of the literature.

A critical review was performed to assess studies about Bowen's disease as a cutaneous predictor of the development of internal malignancy. In six of seven published cohort studies, the authors concluded that there was an association between Bowen's disease and internal malignancy. Three major methodological deficiencies occurred in these studies: lack of an adequate comparison group; inclusion of persons who already had internal malignancy when Bowen's disease was diagnosed; and lack of life-table analysis to describe and to compare cancer incidence rates over time. Though an association between Bowen's disease and internal malignancy may be pathophysiologically plausible and may eventually be demonstrated, we conclude that published reports do not demonstrate that persons with Bowen's disease have an increased risk to develop internal malignancy.