Bowen’s disease, also known as “squamous cell carcinoma in situ”, is a surface form of skin cancer. Named after the doctor that first described it, some 100 years ago, the disease is not serious. This growth of cancerous cells is limited to the outer layer of the human skin. It can, sometimes, progress into squamous cell carcinoma, an invasive form of skin cancer. In this article, you will find everything you need to know about the condition: symptoms, occurrence, causes, warning signs, and the treatment for Bowen’s disease.
Symptoms of Bowen’s Disease
Squamous cell carcinoma in situ usually presents itself as a red, scaly patch on the skin. More often, we observe it in areas that see a lot of sun exposure. Some may mistake Bowen’s disease for a rash, eczema, psoriasis, or fungus. The patches can sometimes develop a brown color and look like melanoma or a keratosis.
The patch of affected skin can be:
- Wide up to a few centimeters.
Where Does Bowen’s Disease Usually Appear?
Bowen’s disease may appear on more than one patch of skin. It usually occurs on the face, neck, scalp, hands, legs, but also on the genitals. If it develops into a lump or an ulcer, it might be an indication that it has formed an invasive squamous cell cancer.
What Causes Bowen’s Disease?
The main causes for Bowen’s disease are sun exposure, aging, the wart virus, arsenic, and a previous injury.
Just like any other type of skin cancer, Squamous cell carcinoma in situ can be caused by prolonged sun exposure, as well as aging. These are the two primary causes of the disease, but other three less common factors can be responsible.
Infection with the wart virus is another cause for Bowen’s disease. Doctors believe that the infection with the wart virus can be one of the reasons why some individuals end up developing SCC.
Bowen’s disease may also be seen as a side effect of radiotherapy or longstanding arsenic ingestion. Nowadays, arsenic ingestion is very rare, but the chemical can be used as an ingredient in some medical prescriptions. Some old water wells may still be contaminated with arsenic. While people suffering from mild arsenic poisoning do not die, they have a higher chance to develop a form of cancer.
Lastly, people who have had an injury to the skin that has caused scarring (or other chronic skin damage), also have an increased risk of developing Bowen’s disease in that area.
On the bright side, this disease is not hereditary. However, people with fair skin have a higher chance to suffer from Bowen’s. SCC is not infectious, and there is no risk of passing it on to others.
Signs that You Should See Your GP
If you have a persistent red or pink, scaly area (that may or may not itch) on your skin and are not aware of any cause for it, schedule an appointment with your general practitioner. Someone other than a doctor can easily misinterpret squamous cell carcinoma as eczema or psoriasis. Therefore, do not rely on self-diagnose. A dermatologist will most likely take a biopsy to make the final diagnosis.
Treatment for Bowen’s Disease
A skin specialist will discuss the treatment options with you if you have SCC. He will not use just one treatment to treat all patients. It depends on a number of things, including the size of the affected area, its thickness, the location, and how many patches are present on the skin.
The dermatologist may recommend:
- Waiting. Doctors may advise patients to wait and observe the development of the disease. A slowly growing patch of Bowen’s disease is difficult to heal. Some may have to wait before further action.
- Applying Creams. Ointments that include 5-fluorouracil can kill the abnormal cells in some cases. Sufferers must apply the 5-FU cream once or twice a day for about a month or even less until healed. Unfortunately, these creams are often irritant. Consequently, the patch of affected skin may end up looking worse than it did before the treatment.
- Undergoing Cryotherapy. This treatment involves liquid nitrogen. Done only in the clinic, the liquid nitrogen is sprayed by the specialist onto the patch of affected skin, freezing it. This procedure can be quite painful and ulceration is a possible side-effect. The patch will scab over and heal over the course of a few weeks.
- Trying Curettage. This medical procedure means that the affected area is “scraped” off the skin with a curette. Before curettage, the doctor will use a local anesthetic to numb the skin. After the treatment, a scab will form, which will then fall off. Patients should leave the skin to heal naturally. This treatment is less painful than cryotherapy.
- Scheduling Surgery. This is often recommended if SCC is carried around the anus. In delicate cases such as these, surgery may be the only option. This involves cutting around the affected area and placing stitches to close up the cut. The healing process may be more difficult, and the stitches may leave a scar.
- Receiving Photodynamic Therapy. This treatment is carried out by a specialist who will apply a specific chemical (a light-sensitive cream) to the lesion. Then, the doctor directs the laser onto the patch to activate the chemical. The light will burn and kill the abnormal cells. This method can be painful and it can lead to inflammation. A session lasts for approximately 20 to 45 minutes, and some individuals may need more than one session.
- Going through Radiotherapy. It is a less common treatment for Bowen’s, and it is not suitable to treat lesions below the knee. Radiotherapy is preferable in patients who are prone to keloid formation. This method has a high cure rate. However, there still some notable concerns. Some specialists are afraid of the toxicity of radiotherapy when it comes in high doses applied to large patches of skin.
After any treatment, there is a 1 in 10 chance that SCC will reoccur. Therefore, patients need to do regular follow-ups to look for signs of recurrence. The outlook, however, looks very good for most people with Bowen’s. The vast majority will not develop a severe form of skin cancer.
How Can We Prevent Bowen’s Disease?
- Excessive sun exposure is the primary risk factor for this disease. Therefore, we should limit sun exposure during the summer months or all year round, depending on country and climate.
- Dermatologists recommend applying a sunscreen of at least SPF15 for adults and SPF30 for children or individuals with fair skin.
- Regularly check the skin for red/pink patches. The sooner you notice the lesion, the better the results of any method of treatment.
In conclusion, the therapy for Bowen’s disease is quite straightforward, and people suffering from it have an excellent prognosis.