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The relationship of Bowen's disease to internal malignancy is controversial. We have studied 72 cases of Bowen's disease and compared them with 58 cases of non-Bowen's squamous intraepidermal neoplasia (SIN). Clinical data were obtained in all cases in an attempt to identify carcinogens and to detect the occurrence of other cutaneous or internal malignancies. Internal malignancy was not found more commonly in patients with Bowen's disease than in those with other forms of SIN. However, 5.7% of all patients win SIN were found to have a concurrent internal malignancy. Other cutaneous malignancies were also more frequent in these groups and may relate to sun exposure. Evidence for arsenic ingestion was not found in most patients. We believe that SIN either as Bowen's or non-Bowen's type may serve as an important marker for the presence of internal malignancy.

In a retrospective study of 581 patients with a diagnosis of Bowen's disease (BD) treated over a 40-year period, we traced patient records to identify later diagnoses of nonskin cancer. Fifty patients had nonskin cancer, as against an expected number of 40, but this difference was not significant. The lack of association was equally true for BD on sun-exposed and non-sun-exposed skin. Our findings support the view that BD is not a skin marker for internal malignant disease.

Six patients with epidermodysplasia verruciformis (EV) were studied for natural killer cell (NKC) cytotoxic response of their peripheral blood mononuclear cells against K-562 target cells in an 18-hour chromium 51-release assay. Four patients displayed higher cytotoxic responses than controls did, whereas two others did not differ from controls. Patients with EV who had increased NKC activity were found to be infected with potentially oncogenic human papillomaviruses (types 5, 8, 9, 14, 17, 19, 22, 24, and others), and they have had multiple skin carcinomas and/or Bowen's precancerous dermatosis. Two patients with EV who had normal cytotoxic response were free of skin malignancies.

Epidermodysplasia verruciformis is a rare, often hereditary disease characterized by a generalized cutaneous infection with human papillomavirus (HPV), depressed cell-mediated immunity, and a propensity for transformation of the warty lesions to squamous cell carcinoma on primarily sun-exposed areas of the skin. A 37-year-old man with congenital lymphatic dysplasia and a history of squamous cell carcinoma of the groin and foot was observed by us to have edema of all four extremities, numerous flat warts, and pityriasis versicolor-like papules over the trunk and arms. Condylomatous lesions were noted in the groin and a periungual verrucous nodule on the thumb. Biopsies showed the trunk and arm lesions to be verrucae and the thumb lesion to be Bowen's disease. Results of molecular hybridization studies from four lesions of the arms showed the presence of only HPV 3 DNA; HPV 16-related DNA was detected in the intraepidermal carcinoma on the thumb. Immunologic evaluation revealed anergy to routine skin testing, depressed mitogen-stimulated lymphocyte transformation, decreased B-lymphocyte count, and a severe reversal of the T-lymphocyte helper:suppressor ratio.