The centennial of Bowen’s disease—a critical review on the occasion of the 100th anniversary of its original description

Abstract

Some issues are extremely simple if looked at without prejudice. This is also true for carcinomas. Carcinomas are malignant neoplasms of epithelial cells. Where are they going to arise? In the epithelium. Therefore, at the outset, they must be confined to the epithelium. How are they going to look in the beginning? Small and inconspicuous. How are they going to develop? They will grow and unfold the capacities with which they are endowed unless they are destroyed. This is nothing special but true for every living matter.

But unprejudiced reflection is difficult because we all adopt conceptions of our time that channel our thinking. For many centuries, carcinomas were never treated before they had metastasized. Recurrences were soon to occur, and most patients died shortly after seeking treatment. The incurability of cancer was so deeply rooted in the worldview of physicians that the diagnosis of cancer was always challenged when a patient survived. Because carcinomas were excised only in stages far advanced, the bulk of the tumor was present in the dermis or deeper structures. That circumstance prompted Rudolf Virchow in 1855 to suggest derivation of carcinomas from cells of connective tissue, a concept to which he adhered for many years afterward. In 1865, Carl Thiersch proved the epithelial origin of cancer, but he believed that the true reason for the epithelial proliferation was a pathological weakness of the connective tissue that enabled sprouts of epithelium to grow in. As late as in 1894, Hugo Ribbert averred that carcinomas did not result from growth of epithelium into connective tissue but from growth of connective tissue into the overlying epithelium [1].