Are there any specific risk factors I should consider when assessing a patient for Bowen's disease?

When assessing a patient for Bowen's disease, key risk factors to consider include chronic ultraviolet (UV) radiation exposure, immunosuppression, and older age. Chronic UV exposure is the primary environmental risk factor, as Bowen's disease is a form of squamous cell carcinoma in situ often arising on sun-exposed skin areas NICE NG12. Immunosuppression, such as in organ transplant recipients or patients on long-term immunosuppressive therapy, significantly increases the risk due to impaired immune surveillance NICE NG12. Additionally, older adults are more commonly affected, reflecting cumulative UV damage over time Szeimies et al. 2005. Other contributory factors include exposure to carcinogens like arsenic and human papillomavirus (HPV) infection, which have been implicated in some cases Szeimies et al. 2005. Therefore, a thorough history should focus on UV exposure, immunosuppressive status, age, and possible carcinogen exposure to identify patients at higher risk for Bowen's disease.