Bowen’s Disease: Causes, Symptoms, Treatment, Prevention, Risks Factors

Overview

Bowen’s disease is an early form of skin cancer. It is also known as squamous cell carcinoma (SCC) in situ, a skin cancer, as it is formed on the top layer of the skin. It is a slow-progressing cancer. It is often confused with other skin conditions, including eczema or psoriasis. 

It is an easily treatable disease with timely medical intervention. The blog explains  Bowen’s disease, its symptoms, causes, diagnoses, treatment options, and preventive methods. 

What is Bowen’s Disease?

As mentioned above, it is an early stage of skin cancer that affects the top layer of the skin, known as the epidermis. It is also known as squamous cell carcinoma in situ. In situ indicates that cancer sits on the upper layer and hasn’t spread into deeper layers of the skin.

The primary indicator of this disease is red, scaly patches on the skin. It is often confused with other skin conditions, such as eczema and psoriasis. As the cancer is slow-growing, it takes time to develop into an advanced type of skin cancer. Therefore, it is vital to get immediate medical attention. Typically, it affects white adults above the age of 60. Men are more susceptible to developing this disease than their counterparts.

What are the Causes of Bowen’s Disease?

The exact cause of Bowen’s disease is unknown. However, the following are factors that may contribute to the development of the condition:

• Long-term sun exposure or extensive use of sunbeds by fair skinned  individuals
• Weak immune system
• Previous exposure to radiotherapy treatment
• The human papillomavirus (HPV) is a sexually transmitted virus that often affects the genital area 
• Chronic exposure to arsenic
• Constant ultraviolet radiation exposure may damage the DNA of your skin. Sunlight, tanning beds, mercury vapor lighting, and halogen and fluorescent light are some forms of ultraviolet radiation exposure

What are the Symptoms of Bowen’s Disease?

For most people, symptoms show up as a single lesion. But some people have more than one lesion. These lesions are often found on your head, neck, palms of your hands, and soles of your feet. If you have skin patches you may experience the following:

• Red scaling sometimes may appear as yellow or white
• Moist pinkness or redness under the patch
• Itching
• Crusty lesions 
• Slow growth
• Pus, if infected
• Defined borders
• The size may be a few millimeters to a few centimeters
• Flat or raised lesions

These lesions may take 2 to 40 years to reach their full size. Therefore it is vital to identify the disease early and get prompt treatment. Sometimes, you may be asymptomatic. In rare cases, you may develop lesions around your genitals.

When to Seek Medical Help?

If you notice symptoms of Bowen’s disease, contact your physician immediately. You may also experience the following:

• Excessive itching
• Redness or discolouration
• Ulceration, where the top layer of the skin is missing
• Crusting and scaling
• Prolonged bleeding
• Infection

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How do doctors diagnose Bowen’s Disease?

As Bowen’s disease shows up as red, patchy lesions, it can be easily mistaken for other common skin conditions, such as rashes, eczema, or psoriasis. Therefore, the doctor may conduct the following tests to diagnose Bowen’s disease:

• Medical history: Your doctor may note down any medical history to understand the cause of your symptoms
• Physical examination: Your doctor may check your lesions for discolouration, scaling, and other signs
• Biopsy: A sample of your lesion is removed to be tested for Bowen’s disease and rule out other skin conditions. 

What are the Various Treatment Options for Bowen’s Disease?

There are several treatment options for the disease. Therefore, it is vital to discuss the most suitable treatment option for you among the following:

If you are diagnosed with Bowen’s disease, your doctor (a dermatologist specializing in skin care and treatment) will probably suggest surgical excision. This procedure involves the removal of the cancerous area, plus about a quarter-inch of surrounding skin. 

In cases of larger patches, Mohs surgery may be necessary. This involves the removal of thin layers of tissue and examination under a microscope for cancer cells. If no cancer cells are present, the surgery is complete. 

In addition to surgery, other treatment options for Bowen’s disease include:

• Cryotherapy: Here, the affected skin gets frozen with liquid nitrogen or argon gas. You may feel pain and can be uncomfortable for a few days. However, over time the skin scabs and falls within a few weeks. 
• Imiquimod cream: You apply the cream regularly on the affected area for a few weeks. Before it gets better, the lesions may appear red, and you may notice inflammation.
• Liquid nitrogen cryosurgery: Your doctor sprays liquid nitrogen onto the affected area to freeze it. Afterward, the area will peel, blister, or scab over, depending on the amount used.
• Laoser removal: Your doctor will use light energy (photons) to burn off the area.
• Curettage and cautery: Curettage and electrodessication: You’re given a shot of anesthetic to numb the area, and your doctor scrapes off the patches with a special tool. Then they’ll use high-frequency electric current to stop the bleeding. They may repeat the process if there are still cancer cells in deeper tissue.
• Photodynamic therapy: After applying a light-sensitive cream on the affected area, a laser beam is directed to the skin for a few hours. It destroys abnormal cells. Each session may last between 8 to 45 minutes. Therefore, you may need more than one session.
• Fluorouracil: The medication is applied to your skin to prevent the cancerous skin from growing and spreading deeper into other layers of the skin. After using the medicine, you may notice redness, soreness, or peeling after a couple of weeks. These signs reduce within a couple of months
• Radiation therapy uses tiny electrically charged electrons to target and kills cancerous cells. It is used only on the upper layer of the skin. Therefore, the layers of your skin and organs are safe. You may have to opt for this method when you have hard-to-treat lesions on your scalp, penis, or anus. 

Who is at Risk of Developing Bowen’s Disease?

You may be at a higher risk of developing the disease if you:

• Have lighter skin
• Are above the age of 60 years
• Are white
• Suffer from photosensitive skin
• Are exposed to the sun for a long duration
• Have a low immune system, and  a history of nonmelanoma skin cancer

How can we Prevent Bowen’s Disease?

You may lower your risk of developing the disease by:

• Limiting or avoiding prolonged exposure to the sun
• Avoiding tanning beds
• Protecting your skin with sunscreen and protective clothing
• Getting regular skin checks

Conclusion

Although Bowen’s disease is early-stage skin cancer, it can spread if left untreated. Therefore, wearing protective layers, applying sunscreen, and limiting your exposure to sun and tanning beds may help prevent the development of the disease. With timely medical intervention, the condition is treatable.

Frequently Asked Questions (FAQs)

Is Bowen’s disease infectious?

Bowen’s disease is not infectious, meaning it does not spread from one person to another

Can you develop the disease as a result of genetics?

Fortunately, genetics do not play a role in the development of the disease, which means it is not passed down from parents to children.

What types of Bowen’s disease are noticed in the genitals?

Skin lesions on the genitals are known as:

• Bowenoid papulosis: It affects men and women equally. The lesions are present in the genital area and can last from 2 weeks to several years
• Erythroplasia of Queyrat: it affects the tip of the penis that may cause ulcers along with discharge, bleeding, itching, and pain when urinating
• Vulvar intraepithelial neoplasia: It affects women and may result in velvety, bright red patches that may itch or burn. The itching can be severe.