What is Bowen’s disease?

Bowen’s disease is a skin disorder that can cause patches of the skin or plaques that in some people may be precancerous.

Doctors also refer to the condition as in situ squamous cell carcinoma. Read on to learn more about Bowen’s disease, including the causes, symptoms, and options for treatment.

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What is Bowen’s disease?

Bowen’s disease is a skin condition which causes red, scaly patches to form on the skin due to changes in skin cells affecting the outermost epidermis layers. According to the American Cancer Society, doctors consider those patches to be the earliest form of squamous cell skin cancer.

Bowen’s disease closely resembles actinic keratosis, another precancerous skin condition that causes the skin to appear in rough, red spots. The principal difference between the two conditions is that patches of Bowen’s disease tend to be larger than patches of actinic keratosis.

Besides affecting the areas of skin that a person can see easily, patches of Bowen’s disease may appear on the anus and genital areas. In these areas, doctors will refer to Bowen’s disease as Bowenoid papulosis, or Queyrat erythroplasia.

Symptoms

Bowen’s disease causes a person to develop skin lesions that are slow to grow. The lesions may appear as red-brown patches or plaques that are dry, scaly.

These patches may also:

  • bleed or ooze pus
  • itch
  • be tender to the touch

Other skin conditions that Bowen’s disease can resemble include:

  • eczema
  • fungus
  • psoriasis
  • some other rashes

Although there is only one lesion in many people with Bowen’s disease, 10–20 percent of people with the condition develop multiple skin lesions in different areas of the body.

Those skin lesions can sometimes become cancerous. For this reason a person with Bowen’s disease should be aware of the signs of cancerous skin lesion. These characters include:

  • hardening of a skin lesion
  • a nodule that feels very tender to the touch
  • the appearance of a flesh-colored nodule or lump
  • a skin nodule that bleeds easily

If a person notices those changes in their skin, they should immediately see a dermatologist.

Causes

The exact cause of Bowen’s disease is not known to doctors but they have identified some risk factors for the condition. Including:

  • aging
  • chronic arsenic exposure — arsenic may be present in contaminated well water and some manufacturing areas
  • chronic sun exposure
  • fair skin with significant sun exposure
  • a history of human papillomavirus, particularly strains 16, 18, 34, and 48
  • a weakened immune system, for example, in those who take steroids for extended periods, live with HIV, or have cancer

According to the National Organization for Rare Disorders, the condition occurs most frequently in Caucasian people over 60 years old.

Treatment

Doctors consider the treatment of Bowen’s disease to several factors. These include the location, appearance, and overall age and health of a person, of any lesions.

Every treatment option has different risks and benefits, and a person should talk to a doctor about these.

Therapy options may include:

  • Cryotherapy: This treatment involves applying a freezing substance — argon gas or liquid nitrogen — to destroy skin cells.
  • Curettage: This surgical procedure uses special tools to burn the lesion and scrape it away from the skin.
  • Photodynamic therapy: A doctor applies a special drug to the Bowen’s disease lesion. The drug reacts to light exposure, damaging and destroying the skin cells.
  • Surgical removal: This approach involves removing the lesion and closing the incision. Some people opt for a special surgical approach called Mohs micrographic surgery, which helps preserve tissue. This option may be ideal for lesions on the head, neck, and fingernails.
  • Topical chemotherapy: Examples include topical applications of 5-fluorouracil and imiquimod 5%.

Doctors do not always recommend treating lesions caused by Bowen’s disease. The lesions grow slowly, at times.

If a person has other conditions that may affect their ability to heal after treatment, such as diabetes, then a doctor may recommend watching and waiting to see how the lesion of the Bowen disease develops before treatment.

Prevention

Minimizing the exposure to a person’s sun can help reduce the likelihood of experiencing Bowen’s disease. Examples of following steps include:

  • refraining from using tanning beds, which increase exposure to ultraviolet light
  • avoiding working outdoors under direct sunlight
  • wearing protective clothing when outdoors, including hats
  • wearing sunscreen with a sun protection factor (SPF) of at least 30 and reapplying it frequently

Limiting exposure to sun may help prevent Bowen’s disease, wherever possible. However, people with no significant sun exposure history can still get Bowen’s disease.

How does it differ from other forms of skin cancer?

There are several types of skin cancer that all differ slightly, including:

  • basal cell carcinoma
  • squamous cell carcinoma
  • melanoma

Bowen’s disease can, in rare instances, develop into squamous cell cancer. In the outermost layers of skin cells this type of cancer is growing.

Due to their location, squamous cell cancers do differ. Basal cell cancers, for example, grow in the lower part of the epidermis.

Melanoma begins in the pigmented portion of skin cells known as melanin.

Outlook

Most people suffering from Bowen’s disease have an excellent outlook, according to a Cochrane Review.

This is because most skin lesions grow very slowly, allowing a person to seek treatment before a lesion can potentially become cancerous. Additionally, there are numerous treatment options for Bowen’s disease, and treatment is generally effective.

Summary

Bowen’s disease is a condition that causes one or more skin lesions which may have painful symptoms at times.

As the condition may develop into skin cancer, doctors may recommend treating skin lesions with surgical removal or other medical approaches.

If a person is concerned about having Bowen’s disease, or notices changes to a lesion of a Bowen’s disease, they should talk to a doctor.

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