Bowen’s disease, the precursor to white skin cancer, is easily recognizable by conspicuous areas on the skin. With regular follow-up checks or removal of the affected skin, the risk of skin cancer can be minimized.
What is Bowen’s disease?
Bowen’s disease, also known as carcinoma in situ, is the early stage of white skin cancer. See lawfaqs for Definitions of Hypoalbuminemia.
In Bowen’s disease, the cancer cells have so far only been in the top layer of skin and have not yet appeared in the 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 recognized by itchy, reddened and rough patches on the skin. The spread is limited and usually only occurs in one place.
These wart viruses, HPV for short, are 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.
Bowen’s disease is often associated with regular exposure to arsenic, tar products, or other cancer-causing chemicals.
Cancer-causing viruses of the human papilloma virus (HPV) type 16, 18, 31, 33, 35 and 45 also play a role in the development of Bowen’s disease.
The decision for Bowen’s disease is often also the individual skin type in connection with strong UV radiation over a long period of time. The use of sunscreen with an insufficient sun protection factor and not wearing protective clothing increase the risk of Bowen’s disease.
But genetic factors, X-ray radiation, immunosuppression and trauma can also trigger Bowen’s disease.
Symptoms, Ailments & Signs
Bowen’s disease can be diagnosed based on the typical skin changes. These are flat, usually clearly defined reddenings that are easily injured and flaky. They can cause itching and pain, and bleeding when pressed or scratched. The skin defects slowly increase in size and depth and then 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 symptoms mentioned increase in intensity, which often leads to psychological problems. Those affected then develop, for example, depressive moods or social anxiety (especially if the skin changes occur on the face, arms and genital area).
The conspicuous complexion appears mainly in areas that are regularly exposed to UV radiation, i.e. on the face, hands and lower legs. In addition, the defects can occur in the groin and anal region 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 & History
Bowen’s disease occurs more frequently in middle-aged to older people. Especially parts of the body that are frequently exposed to UV radiation are affected by Bowen’s disease. Symptoms are usually irregularly shaped, scaly reddened skin that tends to become itchy and crusting or may develop small sores. The main areas affected, mostly on the legs, hands, head or neck, grow in area and depth over time.
In order to rule out confusion with psoriasis and to diagnose Bowen’s disease, a skin sample must be taken from the affected area of skin. If the disease can be identified as Bowen’s disease, the skin should either be checked regularly or the affected tissue should be removed.
As a rule, complications from Bowen’s disease only occur if they are not discovered and treated in good time. In the worst case, this can lead to skin cancer, from which the affected person dies. Changes occur in different places on the skin. These are usually relatively well demarcated and clearly visible.
The skin is reddened and may flake. Furthermore, it can also cause itching on the skin and lead to very unpleasant feelings. It is not uncommon for Bowen’s disease to be diagnosed late, since the disease shows symptoms similar to those of psoriasis and can therefore be confused with this complaint. Those affected are often ashamed of the symptoms and thus suffer from reduced self-esteem and inferiority complexes.
Bowen’s disease can be treated with various therapies and interventions. With an early diagnosis, the symptoms can usually be limited relatively well, so that skin cancer and other complications do not occur. The treatment does not usually reduce or limit the life expectancy of the person affected. However, patients are still dependent on regular examinations after treatment.
When should you go to the doctor?
Any unusual changes in skin texture should be reported to a doctor. If they spread over the body or increase in intensity, it is advisable to see a doctor as soon as possible. Any pain, itching, or open sores is a cause for concern. If sterile wound care cannot be guaranteed, a doctor should be consulted. If existing wounds enlarge or if pus develops, there is an increased risk of sepsis. A doctor should be consulted, since blood poisoning develops as a potential threat to life. If the skin bleeds as a result of pressure being applied or light scratching, a doctor’s visit is necessary. A special depth of the skin changes is characteristic of Bowen’s disease.
A clarification of the complaints is therefore advisable immediately as soon as the deeper skin layers are affected. In most cases, skin regions are affected by changes that are increasingly exposed to solar radiation. Therefore, a doctor should be consulted as soon as sudden irregularities are noticed on the face, neck, décolleté, hands or legs. If the physical symptoms also lead to mental or emotional problems, a visit to the doctor is also recommended. In the case of persistent mood swings or unusual behavior, the affected person needs medical help. Fears, depressive moods and social withdrawal behavior are signs of a discrepancy that needs to be clarified.
Treatment & Therapy
If a patient has Bowen’s disease, all parts of the body must be thoroughly examined for other affected areas. Occurrences of Bowen’s disease should either be checked regularly so that mutations can be detected at an early stage, or removed immediately. In order to remove Bowen’s disease as thoroughly as possible, not only the affected top layer of skin is removed, but also part of the healthy skin tissue.
As an alternative to surgery, Bowen’s disease can also be treated with light therapy, freezing or tumor-destroying creams. However, since this early type of white skin cancer only affects the top layer of skin 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 good chance that Bowen’s disease will return over the next few years. Therefore, after completing a treatment, the skin should be checked at least once a year.
Outlook & Forecast
The prognosis depends on the timely diagnosis and treatment. Bowen’s disease develops malignant tissue on the skin, which if left untreated can turn into the dreaded skin cancer. If the tissue is removed in time, the prognosis for those affected is good. If it is Bowen’s disease and not skin cancer that has gone beyond it, then the disease has not yet been able to produce secondary tumors, which promises a good chance of healing.
In most cases, the disease can then be completely cured. However, it is still possible for the disease to reappear in those affected in the same place. Therefore, patients should see their dermatologist regularly for a check-up. The prognosis is worse when the tissue altered by the disease has crossed the basement membrane of the skin. The disease can then also spread to other parts of the body of those affected.
The cancerous tissue can then also have a destructive effect there. If timely therapy is missed, there is a possibility that Bowen’s disease as a so-called spinalioma can penetrate into the deeper layers of the affected skin and spread further there. In this case, the resulting life-threatening secondary tumors, also known as metastases, spread throughout the body and can attach themselves to various organs and destroy them. Therefore, Bowen’s disease must be recognized and treated early.
To prevent Bowen’s disease, the skin should be protected from long and intense UV radiation. As a possible protection against solar radiation, avoiding direct sun or looking for shady places can help.
Wearing hats and caps for sun protection and long-sleeved clothing also help reduce the risk of Bowen’s disease from UV exposure. If you have uncovered skin, we recommend using a sunblock with the highest possible protection factor.
Above all, people who are often exposed to the sun or who come into contact with arsenic or tar products at work should visit a dermatologist regularly for checks and have any Bowen’s disease treated and checked at an early stage.
Bowen’s disease can recur even after successful therapy. It is then called a relapse. Regular check-ups by a dermatologist are therefore necessary. This is usually done through a visual inspection. It is first carried out on the previously affected skin areas.
To be on the safe side, the dermatologist will then also check the rest of the body. This is also called “skin screening” and needs to be repeated at least once a year. If the removed area was already close to 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 occurring areas with Bowen’s disease, therapy-related complications are also recognized in good time. In addition, it is better for the future to avoid strong exposure to the sun. If this is not possible, clothing that covers the skin and a wide sun hat will also help.
In addition, sun protection creams with a sun protection factor of at least 40 percent protect against excessive radiation. Very intense solar radiation 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.
You can do that yourself
In the case of a suspected diagnosis of Bowen’s disease, the entire skin surface should be examined for corresponding changes. In addition, regular dermatological follow-up checks are required in order to be able to better assess the course of the disease. Mutations in the skin caused by Bowen’s disease can also be detected by those affected by 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 your own complexion for changes. Even after successful treatment, Bowen’s disease has a high tendency to recur. After all, Bowen’s disease is a precursor to what is known as white skin cancer. Since the patient knows his skin best, regular inspections also reveal very subtle changes, which can already be a reason for further diagnosis by the dermatologist. This is the only way to prevent white skin cancer from occurring in the long term.
Patients with Bowen’s disease should avoid intensive sunbathing for too long for the sake of their skin health. When sunbathing, Bowen’s disease patients should always prefer shady places and ensure adequate UV protection. Using lotions with the highest possible sun protection factor, hats, caps, and long-sleeved clothing can reduce the risk of Bowen’s disease. Anyone who is exposed to products at work that contain arsenic or tar should also have their skin checked regularly, as these substances significantly increase the risk of suffering from Bowen’s disease.