The symptoms of Bowen's disease are the formation of red, scaly patches on the skin, that are caused by the abnormal development of skin cells within the epidermis (outer layer of the skin). The patches are irregular in shape, usually between 1 -3 cm across and may be sore or itchy. Sometimes the patches become scaly, cracked or ulcerated and do not heal over a period of time. They occur most often on the lower legs and trunk, but can occasionally be found on the genitals when the condition is known as Bowenoid papulosis. Bowen's disease is not a skin cancer but is a pre-cancerous condition that is sometimes referred to as squamous cell carcinoma in situ; in around 3-5% of cases it can develop into skin cancer. However, if the condition is spotted and treated in a timely manner, a diagnosis of Bowen's disease will not shorten a patient's life expectancy.
In its early stages, Bowen's disease may be mistaken for other skin conditions such as psoriasis and ringworm. Patches may start quite small at just a few millimetres across and gradually grow larger over time. Most people just have one patch but up to 10% of patients may present with two or more. Your doctor will suspect Bowen's disease from the red, scaly appearance of the skin. In order to make a diagnosis, a small sample of skin will be taken ( a biopsy) and examined in a laboratory under a microscope.
You will probably be referred to a dermatologist if you are suffering from Bowen's' disease. A range of treatment options are available:
Your dermatologist may decide just to observe or "watch and wait." This is an appropriate response for slow-growing patches of Bowen's disease on areas of the body where the skin is thin and delicate, such as the shin.
Creams containing 5-fluorouracil can be applied to the skin to kill off abnormal cells. The creams are usually applied two to three times a day for a period of four weeks; a side effect of this treatment is that the creams can irritate the skin, causing it to become red and sore. Should the problem recur, the treatment can be repeated at a later date.
After anesthetizing your skin, the dermatologist will scrape off the patch of Bowen's disease, as your skin heals a scab will form that will fall away naturally.
The patch of Bowen's disease is frozen off using liquid nitrogen. This procedure can be a little uncomfortable and can also cause ulceration of the skin.
When the patch of Bowen's disease is near the genitals or anus, the diseased skin is cut away and the wound is closed with stitches.
A photosensitive chemical is applied to the Bowen's patch which is then exposed to light. As the chemical reacts to the light it is activated and burns away the diseased skin.
Bowen's disease can be treated with X-rays but this is not commonly used for patches below the knee as the skin on this area is slow to heal.
Bowen's disease is a fairly common condition in the US. It is most often seen in people of Caucasian ethnicity who have pale complexions and are over the age of 60: it occurs more often in females than males. One of the main causes is excessive exposure of the skin to sunlight, so these precautions are helpful:
Patients who have had Bowen's disease should monitor their skins regularly for any changes.