What Is Bowen's Disease?
Bowen's Disease is actually squamous cell carcinoma in situ. It is a precancerous skin growth in its very earliest stage. This means that the cancerous cells are completely confined to within the skin lesion itself. It produces a skin tumor that is very slow growing and tends to spread outwards for some time before (if ever) rooting down and invading deeper skin structures (invasive squamous cell carcinoma). It is only at this invasive point that it has the ability to metastasise and spread to other organs. I must stress here though, that Bowen's disease very rarely develops into squamous cell carcinoma - there is possibly less than a 5% chance according to Macmillan Cancer Support in the UK.
Bowen's Disease Symptoms
It usually starts as an unusual red patch with an irregular border that can resemble sunburn and it may or may not itch. Some areas can be raised with wart-like nodules present. As it grows, it can become necrotic causing a painful ulcer. The areas affected tend to be the head, neck and lower legs mainly due to sun damage, although exposure to arsenic is another major cause meaning that skin tumors can develop anywhere on the body.
Like other types of skin cancer, Bowen's disease is rarely seen in individuals under 40 as it takes many years of sun damage to cause a skin lesion and it is far more common in women than men.
The main approach for Bowen's disease is to remove it only if absolutely necessary. There may be issues to address if a skin growth is on the lower leg of an elderly patient if blood circulation is poor. As they tend to be more of a nuisance, in most instances, it is worth leaving it well alone, providing your GP has you monitored regularly.
Bowen's Disease Treatment
If there comes a time when it needs to be removed, the three main methods of removal are as follows -
- Cryotherapy - Skin growths are frozen using liquid nitrogen, resulting in them sloughing away a few days after treatment.
- Topical Chemotherapy - 5% Fluorouracil (5-FU) gel or cream. It is well documented that this can make your skin very sore until the end of treatment. However, there is a new topical skin treatment available now called Masoprocol, which is less of an irritant but may cause allergic dermatitis in a few people.
- Curettage & Cauterization - The surgeon scrapes the affected area removing the tumor and sealing the damaged vessels with heat to stop further bleeding. This is only an option for small areas.
- Radiotherapy - Radiotherapy uses high energy rays directed exactly on to the skin cancer to destroy the cancerous cells, whilst causing as little damage as possible to the surrounding healthy skin. This is another useful method especially for skin growths on the face. As I talked about above, topical chemotherapy may not be recommended for the face as the area can become incredibly sore. Radiotherapy is carried out in a hospital or clinic, either as a single visit or on a daily basis over a set number of days or weeks.
- Photodynamic therapy (PDT) - I believe this is now the 'patients preferred choice', but from what I have researched, it is still having its own research done as there are two areas of its procedure that are under question. To me, this says that it may not be as reliable as a topical chemotherapy option.
PDT involves applying aminolevulinic acid, which is a light sensitising dye, onto the affected area and exposing it to a wavelength of light. This light therapy destroys the bowen disease cells causing minimal pain and taking significantly less time than if using a topical chemotherapy cream. The guesswork I mentioned earlier is where researchers are unsure of the correct length of time between the application of the light sensitising gel and the application of the intense pulsed light, and which IPL source is most effective.
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