Bowen’s disease, the precursor to white skin cancer, is easily recognizable on the skin by noticeable spots. With regular follow-up or removal of the affected skin, a risk of skin cancer can be minimized.
What is Bowen’s disease?
Bowen’s disease, also called carcinoma in situ, is the early initial stage of white skin cancer. In Bowen disease, the cancer cells are so far located exclusively in the uppermost layer of the skin and do not yet appear in deeper layers of the skin. Bowen’s disease was named after the American dermatologist John T. Bowen, who was the first to describe the disease. Bowen’s disease is usually recognizable by itchy, reddened and rough areas on the skin. The spread is limited and usually occurs in only one location. This wart virus, or HPV, is a chronic infection that can mutate into white skin cancer, a malignant tumor. Bowen’s disease occurs mainly in the second half of life. Men are slightly more prone to developing Bowen’s disease than women.
Causes
Bowen’s disease often occurs in association with regular exposure to arsenic, tar products, or other cancer-promoting chemicals. Also playing a role in the formation of Bowen’s disease are cancer-causing viruses of the type Human Papilloma Virus (HPV) 16, 18, 31, 33, 35 and 45. Decision for Bowen’s disease is often also the individual skin type in connection with strong UV radiation over a long period of time. Especially the use of sunscreen with too low sun protection factor and not wearing protective clothing increase the risk of Bowen’s disease. However, genetic factors, X-ray radiation, immunosuppression, and trauma can also provide a trigger for Bowen’s disease.
Symptoms, complaints, and signs
Bowen’s disease can be diagnosed by the typical skin lesions. These are flat, usually clearly demarcated rednesses that are easily damaged and scaly. They can cause itching and pain, and bleeding occurs with pressure or scratching. The skin defects slowly increase in size and depth and, as they progress, spread to surrounding areas of the body. They are visually reminiscent of psoriasis and are therefore often confused with this disease. As Bowen’s disease progresses, the aforementioned symptoms increase in intensity, often resulting in psychological complaints as well. Those affected then develop, for example, depressive moods or social anxiety (especially when the skin changes appear on the face, arms and genital area). The conspicuous skin appearance is mainly seen in areas that are regularly exposed to UV radiation, i.e. on the face, hands and lower legs. In addition, the defects may appear in the groin and anal regions, as well as on the penis and vulva. If Bowen’s disease is not treated, it can develop into skin cancer. The skin defects then develop into painful nodules and change in color, shape, and size.
Diagnosis and progression
Bowen’s disease is more common in middle-aged to elderly people. In particular, areas of the body that are exposed to UV radiation more frequently exhibit Bowen’s disease. Symptoms are usually irregularly shaped, scaly redness of the skin, which tends to itch and crust or may develop small ulcers. The main areas affected, usually on the legs, hands, head or neck, grow in area and depth over time. To rule out confusion with psoriasis and to diagnose Bowen’s disease, it is necessary to take a skin sample from the affected skin area. If the condition can be identified as Bowen’s disease, the skin should either be followed up regularly or removal of the affected tissue should be performed.
Complications
As a rule, complications from Bowen’s disease occur only if it is not detected and treated in time. In the worst case, this can lead to skin cancer, from which the affected person dies. Changes occur on the skin in different areas. These are usually relatively strongly demarcated and clearly visible. The skin is reddened and may flake. Furthermore, itching of the skin can occur and lead to very unpleasant feelings. It is not uncommon for Bowen’s disease to be diagnosed at a late stage, as the disease shows similar symptoms to psoriasis and can therefore be confused with this condition.Those affected are not infrequently ashamed of the symptoms and thus suffer from reduced self-esteem and inferiority complexes. The treatment of Bowen’s disease can take place through various therapies and interventions. If diagnosed early, symptoms can usually be relatively well limited, preventing skin cancer and other complications. Treatment also usually does not reduce or limit the life expectancy of the affected person. However, patients are still required to have regular examinations after treatment.
When should you see a doctor?
Unusual changes in skin appearance should be presented to a physician. If they spread over the body or increase in intensity, a visit to the doctor is advised as soon as possible. If there is pain, itching or open wounds, there is cause for concern. If sterile wound care cannot be guaranteed, a doctor should be consulted. If existing wounds enlarge or pus is formed, there is an increased risk of sepsis. A physician should be consulted as a potential threat to life develops with sepsis. If bleeding of the skin occurs after applying pressure or light scratching, a visit to the doctor is necessary. Characteristic of Bowen’s disease is a particular depth of the skin lesions. A clarification of the complaints is therefore immediately advisable as soon as the deeper skin layers are affected. In most cases, skin regions that are increasingly exposed to sunlight are affected by changes. Therefore, a doctor should be consulted as soon as sudden irregularities are noticed on the face, neck, décolleté, hands or legs. If there are additional mental or emotional abnormalities due to the physical complaints, a visit to the doctor is also recommended. In case of persistent mood swings or peculiarities of behavior, the affected person needs medical help. Anxiety, depressive moods as well as social withdrawal behavior are signs of an inconsistency that needs to be clarified.
Treatment and therapy
If a patient exhibits Bowen’s disease, all parts of the body must be thoroughly examined for other affected areas. Occurrences of Bowen disease should either be followed up regularly so that mutations can be detected early, or removed directly. In order to remove Bowen’s disease as thoroughly as possible, not only the affected top layer of skin but also part of the healthy skin tissue is removed. As an alternative to surgery, Bowen’s disease can also be treated with light therapy, icing or tumor-killing creams. However, because only the top layer of skin is affected in this early type of white skin cancer and the tumor tissue can be easily removed, surgical removal is the preferred treatment option. Even if the affected skin is removed, there is a high probability that Bowen’s disease will recur over the course of the following years. Therefore, after treatment is completed, the skin should be rechecked at least once a year.
Outlook and prognosis
The prognosis depends individually on timely diagnosis and treatment. Bowen’s disease develops malignant tissue on the skin, this can turn into dreaded skin cancer if left untreated. If the tissue is removed in time, the prognosis for affected individuals is good. If it is Bowen’s disease and not yet skin cancer beyond that, then the disease has not yet been able to deposit daughter tumors, which promises a good chance of cure. In most cases, the disease can then be completely cured. However, it is still possible for the disease to recur in the same spot in affected individuals. Therefore, patients should regularly visit their dermatologist for check-ups. The prognosis is worse if the tissue altered by the disease has exceeded the basement membrane of the skin. The disease can then spread to other areas of the affected person’s body. The cancerous tissue can then be destructive there as well. If timely therapy is missed, there is a possibility that Bowen’s disease can penetrate into deeper layers of the affected skin as a so-called spinalioma and spread further there. The resulting life-threatening daughter tumors, also called metastases, spread in this case throughout the body and can attach themselves to various organs and destroy them.Therefore, Bowen’s disease must be detected and treated early.
Prevention
To prevent Bowen’s disease, the skin should be protected from long and intense UV exposure as much as possible. Avoiding direct sun, or seeking shady places, help as possible protection against sun exposure. Wearing hats and caps for sun protection and long-sleeved clothing also help reduce the risk of Bowen’s disease from UV exposure. For uncovered skin, it is recommended to use a sunblock with as high a protection factor as possible. In particular, people who are frequently exposed to the sun or have occupational contact with arsenic or tar products should see a dermatologist regularly for checkups and have any Bowen’s disease that may occur treated early and followed up.
Follow-up
Bowen’s disease can recur even after successful therapy. It is then referred to as recurrence. Therefore, regular control by the dermatologist is necessary. This is usually done by visual inspection. It is first performed on the skin areas that have already been affected. To be on the safe side, the dermatologist will then also check the rest of the body. This is also called “skin screening” and must be repeated at least once every year. If the removed area was already close to a Bowen’s carcinoma, a temporary examination at shorter intervals is necessary. An interval of six months is sufficient for a period of two years, after which an annual check is sufficient. In addition to newly appearing sites of Bowen’s disease, therapy-related complications are also detected in time. In addition, it is better for the future to avoid strong sun exposure. If this is not possible, skin-covering clothing and a wide sun hat also help. In addition, sunscreen creams with a sun protection factor of at least 40 percent protect against excessive radiation. Very intense sunlight is not only found on southern beaches by the sea. Even in winter, the intensity of the sun is particularly high on the mountains, for example, when it is reflected in the white snow.
What you can do yourself
In case of a suspected diagnosis of Bowen’s disease, the entire skin surface should subsequently be examined for corresponding changes. In addition, regular dermatological follow-up examinations are also necessary to better assess the course of the disease. Mutations on the skin caused by Bowen’s disease can also be detected by the affected person through self-observation. Remissions, i.e. the recurrence of pathological skin changes caused by Bowen’s disease, are not uncommon. Therefore, the most important self-help is to regularly monitor one’s own skin appearance for changes. Because even after successful treatments, Bowen’s disease has a high tendency to relapse. After all, Bowen’s disease is a precursor of the so-called white skin cancer. Since the patient knows his skin best, even very discrete changes are noticed during regular inspection, which may already be cause for further diagnosis by the dermatologist. This is the only way to prevent the occurrence of white skin cancer in the long term. Patients with Bowen’s disease should refrain from intensive, overly long sunbathing for the sake of their skin health. When sunbathing, patients with Bowen’s disease should always prefer shady places and ensure adequate UV protection. The use of lotions with as high a sun protection factor as possible, hats, caps and long-sleeved clothing can reduce the risk of Bowen’s disease. Those who are exposed to products containing arsenic or tar at work should also have their skin checked regularly, as these substances significantly increase the risk of developing Bowen’s disease.
