Introduction

Bowen’s disease, which is named after the doctor who discovered it, is a condition wherein there is a localized skin growth. This means that it is generally confined to one particular area. Other terms one might have heard that is used in relation to this are intraepidermal carcinoma in-situ (cancer, which is confined to the outer dermal layer) or pre-invasive squamous cell carcinoma.

Although, they can be very troublesome for the vast majority of people suffering from it but they cause very little harm to others. The risks of this happening are hard to guess but studies reveal that 3 to 5 out of every hundred of untreated Bowen’s disease generally undergo into invasive squamous cell carcinomas. There are many effective therapies to prevent this happening. This can appear anywhere on the skin but is commonly found on the head, the neck and the skin present at the lower legs. It generally appears as red scaly patches that may itch or even bleed.

The frequency and diagnosing

Bowen’s disease is very frequently noticed in people in their 60s and 70s, and is about thrice more common in women as compared to that of the men.  Long-term exposures to sunlight are causative factors, especially for some lesions but in many cases of Bowen’s disease there is no exact causes noticed.

Bowen’s disease can be diagnosed with a biopsy. This includes a very small part of the affected area being aspirated. A local anesthesia is given to numb that area and the sample is sent to the lab that is strictly observed under powerful microscope. A skin specialist (dermatologist) generally performs the task since it requires accuracy. If the result confirms Bowen’s disease, there are different ways of treatments such as -

Cautiously waiting: Since Bowen’s disease is generally very slow in growth, and only small minority of cases ever turn into cancerous, simply keep watching could be the solution, with regular checkup to make sure the lesion is not turning and this is a perfect acceptable approach.  This is especially beneficial in older patients having lesions at their lower legs wherein healing of the skin after treatment might be difficult

Surgery: This is desirable therapy for smaller areas that can be removed under local anesthesia. Surgery is not advisable for larger areas 

Curettage and electrocautery: This means scraping out the area and by using heat or electricity. This helps stopping any kind of bleeding. A local anesthesia is given before the doctor scrapes out the Bowen’s using instrument that is something like spoon shaped called as curette. An electrically heated loops or needles are then applied to stop the bleeding (cauterize) from the wound and to terminate any remaining abnormal cells. After this therapy, a scar which is different from the normal skin color might develop.  

Topical therapy: This is using some creams those are applied over a period of time onto the affected area.  It is not unusual for the area to become swollen and for it to feel uncomfortable during treatments.  For many years a fluorouracil (5FU) creams have been used for this but recently other formula called imiquimod has been sometimes used as the substitute.

Radiotherapy: Radiotherapy cures Bowen’s disease using high-energy X-Rays capable of destroying the abnormal cells while producing little harm as potential to the normal cells. The therapy works well for Bowen’s disease and might be useful in areas where surgery seems to be difficult or blemishing (such as on the face).

Photodynamic therapy (PDT): This is latest therapy used for different skin conditions. PDT involves lasers or other light sources and they are combined with a light-sensitive drugs (sometimes called a photosensitizing agents) to demolish abnormal cells.

Photosensitizing creams are applied onto the affected area generally 4-6 hours before treatment with the light that lasts about ½ hour to 45 minutes. Afterwards a dressing is done so area is covered and protected from light. Usually more than one treatment is required. PDT may be a useful option for patients with larger areas.

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