What Is Bowen’s Disease

Bowen’s disease, also known as squamous cell carcinoma in situ, is a skin condition characterized by the growth of abnormal cells on the outermost layer of the skin. It is considered a precancerous condition because if left untreated, it can progress to invasive skin cancer. In this article, we will provide you with clear and concise information about Bowen’s disease, including its types, causes, symptoms, diagnostic tests, treatments, and relevant drugs.

Bowen disease is a rare skin disorder. Affected individuals develop a slow-growing, reddish scaly patch or plaque on the skin. Sun exposed areas of the skin are most often affected. Bowen disease only affects the outermost layer of the skin (epidermis). Lesions are usually not painful or may not be associated with any symptoms (asymptomatic).[rx] In most cases, treatment is highly successful. Bowen disease is considered a pre-cancerous condition, although the risk of developing skin cancer is less than 10 percent. The disorder usually affects older adults. The exact cause of Bowen disease is unknown, although there are identified risk factors such as chronic sun exposure. Bowen disease was first described in the medical literature by a physician named JT Bowen in 1912. Bowen disease is also known as squamous cell carcinoma in situ, and is generally considered an early, noninvasive form of intraepidermal squamous cell carcinoma. Intraepidermal means that the disease occurs inside the epidermal layer of the skin.[rx]

Bowen’s disease is a type of skin disorder that primarily affects the top layer of your skin, known as the epidermis. It is named after the Australian dermatologist, John T. Bowen, who first described it in 1912. Bowen’s disease is characterized by the presence of atypical or abnormal cells that have not yet invaded deeper layers of the skin.[rx]

Types of Bowen’s Disease

There is only one type of Bowen’s disease, which is the classic form. However, it’s important to note that Bowen’s disease is sometimes referred to as squamous cell carcinoma in situ (SCC in situ), highlighting its precancerous nature.

Causes of Bowen’s Disease

The exact cause of Bowen disease is unknown. Chronic sun exposure and aging are believed to be two major risk factors for developing the disorder. Individuals with fair skin and individuals who spend a lot of time outdoors in the sun are at a greater risk of developing Bowen disease. Individuals who take drugs to suppress the immune system (usually taken to treat an immune system disorder) are also at a greater risk than the general population of developing Bowen disease.[rx]

Individuals who have cutaneous human papillomavirus (HPV) infection are at risk of developing Bowen disease. Human papilloma viruses are a group of more than 150 related viruses, some of which can cause cancer. HPV 16, 18, 34, and 48 have caused Bowen disease at genital sites. HPV 16 is most commonly associated with the development of Bowen disease. HPV 16 is also the cause of some cases of cervical cancer. Less often, HPV types 2, 16, 34, and 35 are associated with Bowen disease in areas of the body other than the genitals.[rx]

Chronic exposure to arsenic appears to be a risk factor for the development of Bowen disease as well. Arsenic is a tasteless, colorless metal element. Arsenic has many uses in manufacturing and other commercial uses. According to the medical literature, chronic exposure to arsenic can cause Bowen disease, approximately 10 years or so after initial exposure. In the past, arsenic was known to have contaminated well water and was once used in various medical preparations. Arsenic exposure occurs far less often today than it did in the past.[rx]

1. UV Radiation: Prolonged and excessive exposure to ultraviolet (UV) radiation from the sun or tanning beds is a primary cause of Bowen’s disease.
2. Age: It is more common in older individuals, particularly those over the age of 60.
3. Fair Skin: People with fair skin are at a higher risk of developing Bowen’s disease.
4. Previous Skin Cancer: Individuals with a history of skin cancer are more susceptible.
5. Human Papillomavirus (HPV): Certain strains of HPV have been associated with Bowen’s disease.
6. Immunosuppression: Weakened immune systems due to conditions like HIV/AIDS or organ transplants can increase the risk.
7. Chemical Exposure: Contact with arsenic or other chemicals may contribute to its development.
8. Smoking: Smoking tobacco has been linked to an increased risk of Bowen’s disease.
9. Genetics: Some genetic factors may play a role in predisposing individuals to this condition.
10. Chronic Skin Inflammation: Conditions like psoriasis or chronic dermatitis may raise the risk.
11. Xeroderma Pigmentosum: A rare genetic disorder that makes the skin highly sensitive to UV radiation.
12. Medications: Certain medications, like immunosuppressants and long-term use of topical steroids, can be contributing factors.
13. Exposure to Ionizing Radiation: Occupational exposure to ionizing radiation is another potential cause.
14. Chemotherapy: Individuals who have undergone chemotherapy may be at a slightly higher risk.
15. Burns: Severe burns can increase the likelihood of developing Bowen’s disease in the affected areas.
16. Alcohol Consumption: Excessive alcohol consumption may be associated with a higher risk.
17. Chronic Skin Infections: Ongoing skin infections can contribute to the development of Bowen’s disease.
18. Viral Infections: Besides HPV, other viral infections may also play a role in some cases.
19. Family History: A family history of skin cancer can increase the risk.
20. Autoimmune Diseases: Some autoimmune diseases can affect the skin and raise the likelihood of Bowen’s disease.

Symptoms of Bowen’s Disease

Typically, Bowen disease appears as a slow-growing, persistent reddish-brown patch or plaque of dry, scaly skin. These lesions may be flat or slightly raised. The lesions are normally not associated with any symptoms, but, occasionally, can itch, ooze pus (if infected), bleed or become crusted and/or tender. In some cases, the lesions may be warty (verrucous), split open (fissured) or, less often, darkly colored (pigmented). In most cases, there is only one lesion, but in approximately 10-20 percent of individuals multiple lesions may develop usually in more than one area of the body.[rx]

1. Reddish or Pink Patches: Affected skin areas often appear as reddish or pinkish patches.
2. Scaly or Crusty Surface: The patches may develop a scaly or crusty texture.
3. Irregular Borders: The edges of the affected area may appear irregular or poorly defined.
4. Slow-Growing Lesions: Bowen’s disease lesions typically grow slowly over time.
5. Itching or Burning: Some individuals may experience itching, burning, or discomfort in the affected area.
6. Ulceration: In advanced cases, ulceration or open sores may develop.
7. Bleeding: Lesions may bleed intermittently.
8. Enlargement: Over time, the affected area may increase in size.
9. Changes in Skin Color: The skin may become darker or lighter in the affected area.
10. Persistent Lesions: Bowen’s disease lesions persist and do not heal on their own.
11. No Symptoms: In some cases, Bowen’s disease may be asymptomatic and not cause any noticeable symptoms.

Diagnostic Tests for Bowen’s Disease

A diagnosis of Bowen disease is suspected based upon identification of characteristic symptoms, a detailed patient history and a thorough clinical evaluation. The disorder is easily mistaken for other skin disorders such as eczema or psoriasis and can be overlooked because there may be no associated symptoms. Bowen disease may sometimes first be noticed during a routine skin examination.[rx]

1. Skin Biopsy: A small sample of the affected skin is removed and examined under a microscope to confirm the presence of abnormal cells.
2. Dermoscopy: This involves using a special magnifying instrument to closely examine the skin lesions.
3. Reflectance Confocal Microscopy (RCM): RCM uses laser light to create detailed images of skin lesions.
4. Wood’s Lamp Examination: A Wood’s lamp emits ultraviolet light to help identify abnormal skin areas.
5. Skin Scraping: In some cases, a scraping of the skin may be taken for examination.
6. Imaging Tests: If deeper involvement is suspected, imaging tests like ultrasound or MRI may be recommended.
7. Biopsy of Nearby Lymph Nodes: If there is concern about the spread of cancer, lymph nodes in the area may be biopsied.
8. HPV Testing: In cases where HPV is suspected as a cause, specific tests may be conducted.
9. Complete Blood Count (CBC): Blood tests can provide information about overall health and potential signs of infection or inflammation.
10. Medical History and Physical Examination: Your healthcare provider will ask about your medical history and conduct a thorough physical examination.

Treatment Options for Bowen’s Disease

1. Cryotherapy: Liquid nitrogen is used to freeze and destroy abnormal cells.
2. Topical Creams: Prescription creams containing fluorouracil (5-FU) or imiquimod can be applied to the affected area to promote the shedding of abnormal cells.
3. Laser Therapy: A laser is used to vaporize or remove the abnormal cells.
4. Electrosurgery: High-frequency electrical currents are used to cut and remove the lesions.
5. Excisional Surgery: The abnormal tissue is surgically removed, and the wound is closed with stitches.
6. Photodynamic Therapy (PDT): A light-activated medication is applied to the skin and activated with a special light source to destroy abnormal cells.
7. Mohs Micrographic Surgery: A specialized surgical technique that removes layers of skin until no abnormal cells are left.
8. Radiation Therapy: In some cases, radiation may be used to treat Bowen’s disease, especially if surgery is not an option.
9. Chemotherapy: Systemic chemotherapy may be considered if the condition has become invasive and has spread to other parts of the body.
10. Immunotherapy: Medications that boost the immune system’s ability to target and destroy abnormal cells may be used in some cases.
11. Watchful Waiting: In cases of low-risk Bowen’s disease, your healthcare provider may recommend regular monitoring without immediate treatment.
12. Combination Therapies: Sometimes, a combination of treatments may be recommended based on the specific situation.
13. Palliative Care: For advanced cases where cure is not possible, palliative care focuses on symptom management and improving quality of life.
14. Clinical Trials: Participation in clinical trials may be an option for individuals with advanced or hard-to-treat Bowen’s disease.
15. Home Care: After treatment, it’s essential to care for the skin properly and protect it from further sun damage.
16. Regular Follow-Up: Routine check-ups are crucial to monitor for any recurrence or new lesions.
17. Sun Protection: Preventive measures, such as wearing sunscreen and protective clothing, can help reduce the risk of recurrence.
18. Smoking Cessation: If you smoke, quitting can reduce the risk and improve treatment outcomes.
19. HPV Vaccination: In some cases, HPV vaccination may be recommended to prevent future infections.
20. Education and Support: Understanding the condition and seeking emotional support can be valuable during the treatment process.

A wide variety of treatment options exist for individuals with Bowen disease including topical chemotherapy, cryotherapy, curettage, photodynamic therapy and surgery. Most therapies have an excellent response rate and the prognosis of Bowen disease in most cases is excellent. The response to a particular therapy may vary – what works for one person may be less effective in another. A treatment plan for Bowen disease will be tailored to a patient based on what is best for his or her individual case.[rx]

Some individuals may opt for no treatment (watch and wait). Watch and wait refers to when physicians follow a patient with a slow-growing disorder without giving treatment until progression of the disease occurs. This allows some people to avoid undergoing such therapies for many years. Elderly patients with a slow growing lesion in an area where healing may be poor (e.g., lower leg) are candidates for watch and wait.[rx]

Topical chemotherapy involves the application of creams applied directly to the lesion. Two common topical medications used to treat Bowen disease are 5-fluorouracil and imiquimod 5%. These treatments may be used alone or in conjunction with other therapies. 5-fluorouracil works by destroying the abnormal skin cells. Generally, affected individuals apply the cream once or twice daily for at least two weeks if not much longer.[rx]

Imiquimod 5% is generally used for lesions on the lower legs, larger lesions and the erythroplasia of Queyrat variant of Bowen disease.

Many individuals with Bowen disease may opt for surgical removal of a lesion. Straightforward surgical removal in which the lesion is cut out and the wound is closed by sutures may be used. Surgical removal of a lesion is highly successful, but will leave a surgical scar.[rx]

A specific type of surgery called Mohs micrographic surgery is usually not required, but occasionally may be recommended for some individuals with Bowen disease, especially those with larger lesions, recurrent lesions on the head and neck or lesions that are located on areas that require as much preservation of the tissue as possible, e.g. around the nail. With this surgery, a surgeon uses a precise technique to remove the diseased tissue one layer at a time. According to the medical literature, Mohs surgery has the highest cure rate of all treatment options.[rx]

Cryotherapy may also be used to treat Bowen disease. Cryotherapy is the use of extreme cold to freeze and destroy the tissue and cells of skin lesions. Cryotherapy is a minimally invasive treatment option. With cryotherapy a freezing substance such as liquid nitrogen or argon gas is applied directly to the lesion. Cryotherapy is most effective for single or small lesions.[rx]

Another surgical procedure used to treat individuals with Bowen disease is curettage with cautery/electrocautery. With curettage, the lesion is scraped off the skin. The procedure is usually performed under anesthesia. In some cases, curettage may be followed by cauterization, in which the lesion is burned by an electrical charge. This procedure may need to be repeated in some cases and will often leave a small white scar.[rx]

Photodynamic therapy, a procedure in which a drug known as a photosensitizer is used along with a special type of red light, to treat some individuals with Bowen disease who have large or multiple lesions. During photodynamic therapy, the drug is administered to an affected individual and absorbed by the affected cells. A specific wavelength of light is used to activate the drug which binds with oxygen creating a chemical that destroys the affected cells.[rx]

In the past, x-ray or radiation therapy (radiotherapy) was often used to treat individuals with Bowen disease, especially individuals who were poor candidates for surgery or who had multiple lesions. Individuals with lesions on the legs are not recommended for radiotherapy because of poor wound healing in that area. Radiotherapy is used less often for the treatment of Bowen disease today than it was in the past.[rx]

Drugs Used in the Treatment of Bowen’s Disease

1. Fluorouracil (5-FU): A topical cream that promotes the shedding of abnormal cells.
2. Imiquimod: Another topical cream that stimulates the immune system to attack abnormal cells.
3. Diclofenac Sodium 3% Gel: Used topically to treat actinic keratosis, a precancerous skin condition related to Bowen’s disease.
4. Cryotherapy Medications: Liquid nitrogen is used in cryotherapy to freeze and destroy abnormal cells.
5. PDT Medications: Medications activated by light in photodynamic therapy.
6. Chemotherapy Drugs: In advanced cases, systemic chemotherapy drugs may be used, including cisplatin, 5-FU, or methotrexate.
7. Immunotherapy Drugs: Drugs like interferon may be used to boost the immune system’s response.

Bowen’s disease is a skin problem where the top layer of your skin starts to act strangely. It can turn into skin cancer if not dealt with. Here’s the scoop

Now you know the basics of Bowen’s disease. Remember to protect your skin from too much sun, and if you notice any strange skin changes, don’t hesitate to see a doctor. Early detection and treatment can make all the difference.

 

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. Thank you for giving your valuable time to read the article.

References