What is Bowen’s disease?
Bowen’s disease is a rare skin disorder. It causes one or more small patches of red skin. It occurs when there is an abnormal growth of cells in the outer layer of the skin (epidermis) in the affected area. It is not skin cancer, but it is very important because it can sometimes turn into skin cancer. For this reason, treatment is often recommended. A close follow-up is required after treatment to check for recurrence of Bowen’s disease.
This was first reported in the medical literature in 1912 by J.T. described by a doctor named Bowen. Bowen’s disease is also known as squamous cell carcinoma in situ and is generally considered to be an early non-invasive form of intraepidermal squamous cell carcinoma. Intraepidermal means that the disease occurs within the epidermal layer of the skin.
- Squamous cell carcinoma
Causes of Bowen’s disease
In many cases of Bowen’s disease, we do not know the cause. But most often it is related to sun exposure or prolonged use of tanning beds. Since it usually occurs in areas of the body that are not exposed to the sun, it is not the only cause.
People with weakened immune systems are in other links. This may be because they have a disease that affects their immune system. For example, an acquired immunodeficiency syndrome (AIDS). Or they may be taking medications to lower their immunity. For example, after an organ transplant, such as a liver or kidney transplant.
One type of Bowen’s disease is known as bowenoid papulosis. It is associated with a type of virus called human papillomavirus (HPV) 16. This type of HPV is associated with cervical cancer and cancer of the penis.
- Previous diagnosis of skin cancer (of any type)
- A family history of skin cancer
- Older age
- Congenital nevi (moles present at birth)
- Dysplastic nevi (atypical moles)
- Repeated exposure to radiation
- A weakened immune system
- Human papillomavirus (HPV) infection
- Tobacco use
Symptoms of Bowen’s disease
Bowen’s disease usually appears as patches of red scales. Sometimes they appear as raised spots or pimples. Often the affected skin appears red and sore. Bowenoid papulosis usually occurs in the pubic or genital area in both men and women.
The patch may be:
- Red or pink
- Scaly or crusty
- Flat or raised
- Up to a few centimetres across
- Itchy – but isn’t always
The patch can appear anywhere on the skin. But the patch is especially common on exposed areas like the legs, neck, and head. They sometimes affect the groin area and the penis in men. If the patch bleeds, turns into an open throat (ulcer), or develops a lump, it may be a sign that the squamous cell has turned into skin cancer.
Diagnosis of Bowen’s disease
You can’t always tell just by looking at your skin, you have Bowen’s disease. Many other skin conditions look the same. It is confused with malignant disorders such as rash or eczema, as well as melanoma. Your doctor will usually take a biopsy to examine your skin.
Treatment for Bowen’s disease
Treatment for Bowen’s disease depends on the location of the lesions, the number of lesions, the size and thickness of the lesions, the age and health of the patient, the cosmetic outcome, and many other factors.
Treatment options may include:
- Cryotherapy: This treatment involves the use of antifreeze (argon gas or liquid nitrogen) to destroy skin cells.
- Curettage: Procedure to remove the ulcer with a sharp knife called a healer, to stop the bleeding and close the wound.
- Photodynamic therapy: A doctor applies a special medicine to Bowen’s disease wound. Light medicine is exposed to light, damaging, and destroying skin cells.
- Surgical removal: This procedure involves removing the wound and closing the incision. Some people choose a specialized surgical procedure called Mohs micrographic surgery to help with tissue care. This option may be ideal for head, neck, and nail injuries.
- Topical chemotherapy: Examples include topical applications of 5-fluorouracil and 5% imiquimod.
Doctors do not always suggest treating Bowen’s disease lesions. Sometimes the lesions grow slowly.
Helping prevent Bowen’s disease means protecting your skin from sunlight daily.
- Apply a broad-spectrum sunscreen with at least 30 sun protection factors (SPF)
- If you’re sweating or swimming, reapply sunscreen every two hours.
- Stay in the shade
- Wear protective hats and clothing
Departments to consult for this condition
- Department of dermatology