Bowen’s disease is a skin condition characterized by abnormal cell growth in the outermost layer of the skin. It is an early form of squamous cell carcinoma, a common type of skin cancer.
What Bowen’s Disease Is
Bowen’s disease is classified as squamous cell carcinoma in situ, meaning the abnormal cells are confined to the epidermis, the skin’s most superficial layer. This represents a non-invasive stage of skin cancer. It is a slow-growing condition that can develop over months or years. While it can appear anywhere on the body, it is frequently found on sun-exposed areas such as the face, scalp, neck, hands, and lower legs. It can also occur in non-sun-exposed regions or on mucous membranes.
Recognizing the Signs
Bowen’s disease typically appears as a red or reddish-brown, scaly patch on the skin. These patches often have distinct, irregular borders and may resemble common skin conditions like eczema, psoriasis, or ringworm. They can vary in size from a few millimeters to several centimeters. While usually asymptomatic, some individuals might experience mild itching or tenderness in the affected area. In some instances, the patch might become thicker, crusted, or even ulcerated.
Understanding the Risk Factors
Several factors increase the likelihood of developing Bowen’s disease. Prolonged exposure to ultraviolet (UV) radiation from the sun is a primary contributor, especially for people with fair skin prone to sunburn. The condition is more common in older adults, typically those in their 60s and 70s.
Previous skin damage, such as from radiation therapy, can also be a factor. Human papillomavirus (HPV) infection, particularly certain strains, is linked to Bowen’s disease, especially in genital or perianal areas. Immunosuppression, often seen in organ transplant recipients or individuals with weakened immune systems, also elevates the risk.
Diagnosis and Treatment
Diagnosis of Bowen’s disease typically begins with a dermatologist examining the suspicious skin lesion. To confirm the diagnosis and rule out more invasive skin cancer, a skin biopsy is performed. This involves removing a small sample of the affected tissue, often through a punch or shave biopsy, which is then examined under a microscope. The biopsy helps differentiate Bowen’s disease from other conditions that might look similar.
Treatment options for Bowen’s disease vary depending on the lesion’s size, location, and the patient’s overall health.
Surgical excision: The lesion is cut out, common for smaller areas.
Cryotherapy: Abnormal cells are frozen with liquid nitrogen, causing them to blister and fall off.
Topical chemotherapy creams: Such as 5-fluorouracil, can be applied directly to the lesion over several weeks to destroy the abnormal cells.
Photodynamic therapy (PDT): Uses a light-sensitive cream activated by a specific light source to eliminate the affected cells.
Curettage and electrodesiccation: The lesion is scraped away, and the area is treated with an electric current to destroy remaining cells.
Prognosis and Follow-up
When diagnosed and treated early, the outlook for individuals with Bowen’s disease is generally favorable. Effective treatment typically leads to a cure. However, if left untreated for an extended period, there is a small possibility, 3% to 5%, that it could progress to invasive squamous cell carcinoma, which can spread to deeper skin layers. After treatment, regular follow-up skin examinations are important to monitor for any recurrence of the treated lesion or the development of new ones. Individuals who have had Bowen’s disease are at an increased likelihood of developing other skin cancers, making consistent skin surveillance part of long-term care.