Bowen's Disease

While Bowen's disease is not classed as non-melanoma skin cancer, and the disease itself is not usually serious, the concern is that it is a precancerous form of squamous cell carcinoma (SCC) - sometimes referred to as ‘squamous cell carcinoma in situ.’

Overview

It's estimated that between 1 in 20 to 1 in 30 people with untreated Bowen's disease develop SCC, and although squamous cell skin cancer is often treatable, it can spread deeper into the body and is sometimes very serious.

The lesions, or ‘patches’ caused by Bowen’s disease tend to grow very slowly over months or years, and may present similarly to other skin conditions, like psoriasis or eczema, so this is why suspected pre-cancerous lesions should always be checked by a medical expert.



If Bowen’s disease is left undiagnosed or neglected, patients who have it may increase their risk of skin cancer.



Symptoms of Bowen’s Disease

Bowen's disease typically presents as a patch on the skin that has clear edges, and does not heal.

It is possible to have more than a single patch, and it may look like other skin conditions, like psoriasis or eczema, so it is important to get any suspicious growths checked out by your GP.

A Bowen’s disease lesion can be;

  • Red, pink or sometimes brownish in hue
  • Scaly or crusty in texture
  • Either flat or raised
  • Up to a few centimetres wide
  • Itchy, but it doesn’t need to be itchy all the time

Bowen's disease lesions can appear on skin anywhere on the body, but they are especially common on areas that are exposed to UV light, like the lower legs, neck and head.

Sometimes they can affect the groin area, and lesions that appear on the genitals can cause other problems. In that area, Bowen’s disease may be called one of the following:

This condition of lesions in the genital area can affect both men and women. The lesions last anywhere from 2 weeks to several years, so it is important to see a doctor even if a lesion has appeared to resolve.
Otherwise known as Erythroplasia of Queyrat - This condition affects the tip of a man’s penis, and may cause ulcers. Other symptoms could include itching, discharge, bleeding, or pain during urination. The symptoms may be confused with a sexually transmitted infection (STI), and so some men may be worried or embarrassed about seeking treatment, or letting their partner know they have a problem.
This condition affects women and can cause velvety, bright red patches that may itch or have a burning sensation. This itching can be quite severe, and the symptoms may be confused with a sexually transmitted infection (STI), and so some women may be worried or embarrassed about seeking treatment, or letting their partner know they have a problem.

Some signs that a Bowen’s disease patch has turned into SCC are if;

  • The lesion bleeds, either regularly or intermittently; 
  • The lesion changes, turning into an open sore (also called an ulcer);
  • The lesion develops swelling or a hard lump.

It is vital that patients worried about a lesion visit their GPs, who are often able to diagnose pre-cancerous lesions. The GP may refer the patient to a dermatologist for treatment – which may include a biopsy - if they feel it is appropriate.

Whether or not a patient has had previous skin cancer or suspicious growths, it is important for individuals to self-monitor for any changes, and follow up with their GP, especially if they are at higher risk, have been asked to keep an eye on a lesion, or have any concerns.

Causes of Bowen’s Disease

Bowen's disease and other pre-cancerous lesions often develop as a result of exposure to ultraviolet (UV) light, and thus most often present in skin that has been regularly exposed to the sun – such as the face, ears, hands, shoulders, upper chest and back. However, the popularity of unhealthy exposure to UV light – whether sunbathing on holiday, or the use of harmful tanning beds – means Bowen’s disease may develop in other areas, and it can also develop in areas of the body that have not been exposed to UV light.

Bowen's disease usually affects older people, typically over 60 years of age. It’s usually not genetic – although people may have a family history of skin cancers. The condition is non-infectious, meaning it can’t be transmitted to others.

Factors that may mean someone has an increased susceptibility to Bowen’s disease include;

  • Previous skin cancer
  • A family history of skin cancer
  • Fair, or pale skin that burns easily
  • Working outdoors
  • Immunosuppression due to diseases that affect the immune system, such as HIV or leukaemia
  • Immunosuppressive medication, such as methotrexate, ciclosporin and azathioprine
  • Previous radiotherapy treatment
  • The virus HPV (human papillomavirus)
  • Historic arsenic poisoning

Patients can assist in managing their Bowen’s disease by self-monitoring their skin for any changes, undergoing annual follow-up appointments, and being vigilant against lifestyle factors that increase risk.

While adhering to sun awareness advice – for example, staying out of the sun (especially during midday hours) and applying a broad-spectrum sunscreen - is best practice for everyone, patients who have previously had Bowen’s disease, other pre-cancerous lesions or non-melanoma skin cancers should take all precautions to avoid harmful UV rays. Staying in the shade, wearing a wide-brimmed hat and UV-blocking sunglasses outdoors are all recommended.

Treatment of Bowen’s Disease at Derma

Your appointment with the dermatologist will begin with analysis of the affected area and possibly a full skin check if indicated, and together you will discuss your medical history, before a course of treatment for Bowen’s disease is recommended.

There are a number of treatment options for Bowen's disease, and the dermatologist will help you identify which are suitable, and which option is best for you.

Some patients’ lesions can be treated with cryotherapy, in which liquid nitrogen is sprayed onto the affected area. Photodynamic therapy, also known as PDT uses a light source to destroy the abnormal cells. Each of these treatments may need to be repeated, depending on the individual patient.

Bowen’s disease can be treated by excision, and sometimes shave excision, which are relatively painless procedures that can be performed efficiently and effectively under local anaesthetic. Depending on insurance, treatment can be carried out the same day as the consultation.

Sometimes you can be prescribed a special cream that will deliver treatment to the lesion over the course of several weeks.

In a few cases, your dermatologist may advise monitoring your skin closely and making lifestyle changes, for example, if the lesion is very slow growing, and the effects of treatment would outweigh the benefits.

Please note that further tests – such as a biopsy – may be necessary. Follow-up appointments will be required to ensure that the Bowen’s lesion is properly treated, and your skin monitored for any changes, as pre-cancerous lesions is likely to indicate an increased susceptibility to non-melanoma skin cancer. Your dermatologist will discuss this with you and you’ll be able to ask any questions during your consultation.

We see and treat more skin cancer patients than any other doctors in Reading, so you can be assured that Derma will provide the very best care, the latest research and the most effective treatments.

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