Bowens Disease is a pre-cancerous and neoplastic skin condition, characterized by the development of abnormal scaly or thick patches on the skin mostly as a result of prolonged and frequent exposure to arsenic and sun. The thick patches grow slowly to take a malignant form. The disease was named after Dr John T. Bowen, who was the first to discover it in 1912.

Medically Bowen's disease is considered to be equivalent to "squamous cell carcinoma in situ". Sometimes it is described as the preliminary phase or intraepidermal form of squamous cell carcinoma.

Squamous cell carcinoma refers to development of a tumor from the flat and scale-like squamous cells, in the external layer of the skin. The term "in situ" denotes to original or natural place or site and that in case of cancer, it means that the cells forming tumor still remain confined to their originating place without invading neighboring tissues or metastasizing afar.

Persistence and progressiveness are the important characteristics of Bowen disease, which often look similar to localized thin and abnormal patches of psoriasis, dermatitis, or even a dermatophyte infection.

Diagnosis

Bowen’s disease can be accurately diagnosed with a biopsy, which involves removal of a sample of small part of the affected area for microscopic examination to determine the nature of the cell. Prior to removal of sample, a local anesthetic is given in the affected area so that it becomes numbed.

Causes of Bowens Disease

Flower solution which was previously used in the treatment of psoriasis, Gay solution (previously used in the treatment of asthma), contaminated water of a well and certain pesticides are thought to be the main sources of arsenic exposure.

Bowen's Disease is a skin condition, which can more commonly affect individuals above 40.

Some genetic factors, trauma, exposure to certain carcinogenic chemicals and x-ray radiation may contribute to the development of Bowen's Disease.

Prolonged and frequent exposure to Sun is considered to be the main reason for occurrence of Bowens disease.

The ionizing radiation that may harm the skin pigmentation potentially leads to Bowens disease.

Bowens Disease Symptoms

Slow growth of one of more patches.

Growth looks like an abnormally elevated blemish on the skin and often leads to bleeding.

Appearance of a flat, scaly, reddish and slightly elevated skin patches- each with irregular edge and different from surrounding skin.

Though skin patches may develop any part of the body, they commonly appear on skin of lower leg.

Patches are often overlooked, as they do not show any sign or symptom.

Bowens Disease Treatment

Wakeful observation: Bowen’s disease grows very slowly and that only few cases turn into a cancer. Considering the slow growth of the condition it is necessary to become observant through regular check-ups and see if lesion is changing or not. This can be true for the aged patients having lesions on their lower legs where it becomes difficult to ensure healing of the skin after treatment.

Surgery: Surgery can be appropriate option for removal of small areas under local anesthetic. Surgergical treatment may not be suitable for large areas.

Curettage and electrocautery: This technique can be adopted to scrap away the area and use heat or electricity for stopping bleeding. Prior to this, a local anesthetic is given to the patient to numb the affected portion of the body. The growth is scrapped away with the use of an instrument called curette having a shape a spoon and then an electrically heated loop or needle is applied in order to check bleeding from the wound and wipe out the remaining abnormal cells. This type of treatment may lead to development of scar with a color different from normal skin color. Curettage can be appropriate for small patches.

Topical therapy. This type of treatment involves use of a cream, called fluorouracil (5FU) for application to affected area for some time. The patient undergoing this type of treatment usually feels discomfort and inflammation of the affected area. The treatment may alternatively include a drug called imiquimod.

Radiotherapy: Radiotherapy involves use of a high- energy x-rays for destroying the abnormal cells without affecting normal cells. It can be an effective treatment in case of Bowen’s disease. Radiotherapy can be adopted for those areas where surgery becomes difficult or causes disfigurement.

Photodynamic therapy (PDT): PDThas emerged as a latest method, which can be adopted for different skin conditions. PDT incorporates the use of laser or light sources and a light-sensitive drug for destroying abnormal cells.

The treatment starts with application of a photosensitizing cream to the affected portion nearly six hours before the use of light for about 20-45 minutes. Now the affected area is covered with dressing so that it remains unaffected by light. PDT can be more effective for those having large areas of Bowen’s disease.

Cryotherapy or cryosurgery: This type of treatment involves

spraying of liquid nitrogen on the affected area. This is done mainly to freeze the affected area. Use of liquid nitrogen in has been found to be effective in ensuring quick recovery. This treatment can be better for small or flat lesions.