Bowen’s disease is an early form of squamous cell carcinoma (SCC), a type of skin cancer.
The disease is also known as SCC in situ. The term “in situ” means that it develops on the top layer of the skin, called the epidermis, and remains in the place that it originally developed.
Bowen’s disease typically involves a red, scaly, crusty lesion. The lesion might look like other skin conditions, such as eczema (a condition that makes your skin red and itchy) or psoriasis.
Since Bowen’s disease is an SCC, it’s important you get medical attention right away. Read on to learn about the causes of Bowen’s disease, plus how it’s diagnosed and treated.
For most people, Bowen’s disease is characterized by a single lesion. About
- red scaling, though it could appear as white or yellow
- moist pinkness or redness under the scaling (in all skin tones)
- lack of bleeding in the area
- itching (some of the time)
- plaques are flat or slightly raised or may appear as nodules as they develop
- slow growth
- pus (when infected)
- defined borders
- size is between a few millimeters to a few centimeters
It can take 2 to 40 years for your lesion to reach its full size, so it’s important for you to get it identified and treated early.
For some people, their lesions might be asymptomatic and cause no symptoms at all.
The specific cause of Bowen’s disease is currently unknown. But there are certain factors associated with the disease.
Chronic ultraviolet (UV) radiation exposure
Prolonged exposure to ultraviolet (UV) radiation is a major contributor to Bowen’s disease.
Over time, UV radiation damages the DNA in your skin. This can lead to cancerous conditions like Bowen’s disease.
Sources of UV radiation include:
- tanning beds
- mercury vapor lighting (in stadiums and school gyms)
- some halogen and fluorescent lights
Compromised immune system
The p53 gene is a gene that suppresses tumors. A mutation of this gene can lead to various forms of tumors, including those involved in skin cancer.
A weakened immune system can increase the expression of a p53 mutation. This may cause Bowen’s disease.
Causes of a compromised immune system include:
- taking immunosuppressant drugs
- receiving radiation therapy
- having a genetic disorder
Human papillomavirus (HPV) infection
A human papillomavirus (HPV) infection is another potential cause of Bowen’s disease. Several types of HPV may be associated with the disease.
Chronic arsenic exposure
Arsenic is a metal element that’s toxic to humans. It’s tasteless and odorless.
Chronic arsenic exposure can lead to Bowen’s disease. It takes about 10 years to develop after your first exposure.
Exposure to arsenic can happen due to:
- drinking water that contains arsenic
- smoking tobacco products
- breathing air that contains arsenic
- exposure to landfills or waste sites
- living near industrialized areas
You may be more likely to develop Bowen’s disease if you:
- have lighter skin
- are older than 60
- are white
- have photosensitive skin
- spend a lot of time in the sun
- have a compromised immune system
- have a history of nonmelanoma skin cancer
The following images show Bowen’s disease on different parts of the body, including Bowen’s disease of the nail.
Bowen’s disease is a type of SCC, a type of cancer. It can be successfully treated using various methods, but it should be treated early or else it can become invasive.
The best treatment for Bowen’s disease depends on several factors:
- the size of your lesion
- the location and thickness of your lesion
- your number of lesions
- your age
- your overall health status
- the medications you’re taking
Treatment options include:
The most common option is surgical removal. It’s usually used for smaller lesions.
During the procedure, a surgeon will cut out your lesion, along with a thin margin of normal tissue around it.
This treatment is highly effective. But it will leave a scar.
In topical chemotherapy, a medicated cream is applied to your lesion. These creams work by destroying the cancerous skin cells.
The creams used for this purpose include 5-fluorouracil or imiquimod 5 percent. They may be used in combination with other Bowen’s disease treatments.
Cryosurgery, or cryotherapy, uses extreme cold to kill your abnormal skin cells. It typically uses liquid nitrogen or argon gas.
Generally, this treatment is recommended if you have one lesion at a location on your body that heals well.
Curettage with electrocautery
Curettage is a surgical procedure. It involves scraping the lesions off of your skin.
After curettage, your lesion might be burned with an electrical current. This is called cauterization.
Radiotherapy uses high doses of radiation to destroy the lesion. Types of radiotherapy used for Bowen’s disease include:
- external beam radiotherapy
- a radioactive skin patch
- Grenz rays
Radiotherapy is often used for lesions on areas that are hard to treat, such as your scalp, penis if you have one, and around your anus. Radiotherapy is one of the more expensive treatment options.
Topical photodynamic therapy
In photodynamic therapy, a light-sensitizing agent is applied to your lesion for 3 hours. A light is then projected onto the targeted area, which selectively destroys the damage.
The following methods are used to diagnose Bowen’s disease:
- Medical history. This will help a doctor or healthcare professional understand what might be causing your symptoms.
- Physical examination. A doctor will check your lesions and surrounding skin for discoloration, scaling, and other symptoms.
- Biopsy. A doctor takes a sample of your lesion and examines it under a microscope. This can help them rule out other skin conditions.
See a doctor if you have new, unexplained skin lesions or growths. Symptoms that might mean you have skin cancer include:
There are multiple options for effective Bowen’s disease treatments. So, for most people, the recovery rate is high.
The key is to treat Bowen’s disease as early as possible. That’s because it’s more difficult to treat in its later stages.
Since Bowen’s disease is a type of skin cancer, you’ll need to take certain precautions after treatment. This includes:
- avoiding or reducing sun exposure as much as possible
- wearing protective clothing
- routine skin checkups by a dermatologist
It’s possible to lower your risk of developing Bowen’s disease. This includes:
- limiting or avoiding prolonged sun exposure
- avoiding tanning beds
- applying sunscreen every day
- wearing protective clothing
Getting regular skin checkups can also help catch Bowen’s disease early, when treatment is most effective.
Bowen’s disease is a cancerous condition. It involves scaly patches that can turn into skin cancer over time. The most common cause is prolonged sun exposure, but HPV infections, arsenic exposure, and a compromised immune system can also play a role.
It’s possible to treat Bowen’s disease. Your abnormal skin cells can be destroyed using treatments such as surgical removal, radiotherapy, topical chemotherapy, and cryosurgery.
When treated early, Bowen’s disease has a high recovery rate. The best way to lower your risk is to avoid or limit excess sun exposure.