Bowen Disease

Bowen disease was first described in the early 20th century, about 1912, by JT Bowen; one of the physicians in the medical literature.

Bowen disease is also known as squamous cell carcinoma in situ because it affects the outermost layer of the skin which is made up of cells called the squamous cells.

It is generally known as an early non-invasive form of skin cancer (intra-epidermal squamous cell carcinoma). Been intra-epidermal connotes that the condition occurs inside the epidermal layer of the skin.

Bowen’s disease is a very well-known precancerous lesion whereby squamous carcinoma may develop. The Bowen’s disease is easily treatable, not usually serious; one of its main signs is the appearance of a red, scaly patch on the skin.

The patch is very slow in spreading over months or years and there are several effective ways to treat the condition. But the chance that it can spread deeper into the body and turn into a more serious type of skin cancer if left unattended cannot be overlooked.

Overtime awareness has been made known that, the best and most effective method of reducing the risk of Bowen’s disease as well as other closely related skin complication, is to limit exposure of the skin to sunlight.

The tendency of Bowen’s disease occurrence is very low as it is estimated to occur in 1 in 20 to 1 in 30 people yearly.

Symptoms of Bowens Disease

Bowen’s disease is not known to run in families, and it is not infectious. The disease causes a person to develop skin lesions which appear as red-brown patches, dry and scaly.

The patches may also itch, bleed or ooze pus, become tender to touch. 10 to 20% of people with Bowen’s disease condition develop skin lesions in different areas of the body. Sometimes, the skin lesions can become cancerous. For this cause, persons should be aware of the signs that a skin lesion is cancerous.

These signs include:

  • Hardening of the skin lesion
  • A nodule that feels very tender to touch
  • Appearance of a flesh-colored nodule or lump
  • A skin nodule that bleeds easily

A person should consult a dermatologist immediately if these changes are noticed.

Other skin conditions that Bowen’s disease might resemble include:

  • Fungus
  • Psoriasis
  • Eczema
  • Other type of rashes

How is Bowens Disease Differ from other Types of Skin Cancer?

Physicians and Public Health workers are always confronted by this question; “how are you sure it’s not skin cancer?” Well, there are several types of skin cancer that differ slightly based on the location on the layer of the skin.

In very rare instances, Bowen’s disease can evolve into squamous cell cancer, this type of cancer grows in the outermost layers of the skin cells. Squamous cell cancers are different due to their location.

For example, basal cell cancers grow in the lower part of the epidermis. Melanoma starts in the melanin, the pigmented portion of the skin cells.

Causes of Bowen’s Disease

Bowen’s disease is rare and statistics on reported cases over the years, according to the National Organization for Rare Disorders, reveals that people usually affected are Caucasians and older citizens; people of ages between 60s to 70s.

Though the primary cause of Bowen’s disease is unknown, but it has been closely linked to some conditions:

  • Long term and exposure to radiotherapy treatment
  • HPV (Human PapilomaVirus) – a common virus known to often affect the genital region and cause genital warts.
  • Long term exposure to sunlight
  • Use of sun beds over a long period of time- especially in people with fair skin
  • Weak immune system- common to patients under medications to suppress their immune system after an organ transplant or those with AIDS or cancer.
  • Aging
  • Chronic chemical exposure such as arsenic exposure- arsenic may be present in contaminated pools or well water and some manufacturing areas.

Prevention of Bowen Disease

Most skin diseases and skin related conditions seem to be closely linked to ultraviolet (UV) light exposure. Some measures can therefore be put in place to prevent Bowen’s disease, examples of such measures include:

  • Use of protective clothing: pants, long-sleeved shirts and broad brimmed hats.
  • Sun avoidance: minimizing outdoor activities during hot sunny days between 11 AM and 4PM when the sun rays are strongest, seeking shades, avoid sunbathing and use of tanning beds (which increase exposure to ultraviolet light).
  •  Use of sunscreens with a sun protection factor of at least 30; always reapplying it frequently.

Limiting sun exposure, anytime possible, may help prevent Bowen’s disease. However, people who do not have a significant history of sun exposure may likely still get Bowen’s disease.

Treatments of Bowen Disease

Bowen’s disease can spread even to deeper layers of the skin. A dermatologist, who specializes in skin care and treatment of skin disorders, will recommend something called surgical excision; a medical procedure where they gently remove the cancerous area and about a quarter inch beyond and around the diseased site.

But if a patient has a larger patch, he or she may need a more detailed procedure called Mohs surgery. In this procedure, a thin layer of tissue is removed and examined under a microscope.

If cancer cells are observed in the outside edges of the tissue, another thin layer is removed and also studied. When no cancer cell is discovered in the latter skin sample, the surgery is over as the patient is declared to be out of risk.

Besides surgery, other treatment options that can be recommended by a dermatologist include:

Curettage and electrodessication

Involves the use of anesthetics to numb the site, the patches are scrapped off with special tools and high frequency electric current are used to stop the bleeding. The process may be repeated if cancer cells are discovered in deeper tissue layers.

Imiquimod

This treatment involves the use of a medication. Applied on the skin, it is unknown to physicians how it works against cancer, but it is known for warts treatment.

Flurouracil

This is also a medication applied on the skin. It is used to keep the abnormal cells from reproducing and spreading. Though it has some side effects like redness and soreness, and peeling after 2 weeks, but this usually goes away within a month or two.

Cryotherapy

The treatment involves the application of freezing chemical, such as argon gas or liquid nitrogen to destroy the affected skin cells.

Photodynamic therapy

This treatment involves the use of ultraviolet light rays to heal the skin. Medication is also applied on the skin to make the cells more sensitive to the light.

Radiation therapy

The type of radiation therapy uses to treat Bowen’s disease, uses very tiny electrically charged particles (electrons) to target and kill affected cells. This type of radiation enters only the upper layers of the skin, so deeper tissues and organs are safe.

Summary

If a person is concerned that they have Bowen’s disease, or they notice changes to a Bowen’s disease lesion, they should speak to a doctor. These lesions may sometimes have painful symptoms. As the condition can develop into skin cancer, doctors may recommend surgical removal or other suitable medical approaches to treat the skin lesions.

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