Generality
Bowen's disease is the earliest form of a skin cancer other than melanoma, known as squamous carcinoma.
Bowen's disease is due to causes that are still unknown in detail; it is certain, however, that factors such as, for example, excessive exposure to the sun or tanning lamps, fair skin and immunosuppression affect its appearance.
To distinguish Bowen's disease is the formation of an abnormal skin spot: the latter is the tumor.
For the diagnosis of Bowen's disease, physical examination, history, and tissue biopsy are essential.
Bowen's disease is a treatable condition with excellent results, provided that the therapy - consisting of a work to remove the skin stain - is timely.
A brief review of what Skin Squamous Cells are
Squamous cells are more or less subtle cellular elements, which take place in the most external states of the skin, ie in the epidermis .
Squamous cells have a limited life; after a few weeks of their formation, in fact, they die and give way to completely identical new scaly cells, which, in turn, are destined to meet the same fate (death and replacement).
The squamous cells belong to the family of the so-called keratinocytes, ie the cells that produce keratin .
What is Bowen's disease?
Bowen's disease is a very early form of squamous cell skin cancer; in other words, therefore, Bowen's disease is a malignant tumor of the skin at the earliest stages, which originates from the uncontrolled proliferation of a squamous cell.
Belonging to the category of non-melanoma skin tumors, Bowen's disease is an example of carcinoma in situ and this explains why in the medical literature it is also indicated with the expression " squamous carcinoma in situ ".
Bowen's disease falls into the big category of skin diseases .
What are a carcinoma and a carcinoma in situ ?
In the medical field:
- The term "carcinoma" identifies any malignant tumor (or cancer) that originated from the uncontrolled proliferation of a cell belonging to an epithelial tissue,
while
- The expression "carcinoma in situ " describes the carcinomas at their onset, when they do not yet possess the same infiltrating and metastasizing capacities as the actual carcinomas.
In other words, carcinoma in situ is a carcinoma in the immature phase (so much so that its cells have not yet assumed all the typical behaviors of cancer cells).
Is Bowen's Disease a Severe Disease?
Bowen's disease is not a particularly serious tumor ; however, if his diagnosis is late or inadequate treatments, he could become one, as he has the ability to evolve into a real carcinoma.
When Bowen's disease passes from being a carcinoma in situ to being a real carcinoma, it becomes an example of squamous carcinoma (also known as spinocellular carcinoma, squamous cell carcinoma, squamous cell epithelioma and spinalioma ).
According to some statistical studies, the transformation of Bowen's disease into squamous carcinoma would affect 1 subject every 20-30 affected by the condition (ie about 3-5 patients per 100).
Causes
Similarly to other forms of cancer, Bowen's disease is also the consequence of a slow accumulation of genetic mutations, on the part of the DNA of one of the cells that make up the organ or tissue concerned (the epidermis, in the case of the disease of Bowen). In fact, these mutations are responsible for the characteristic phenomenon of uncontrolled proliferation that characterizes the formation and growth of malignant tumors.
Despite numerous research on this subject, doctors have not yet identified the precise causes of the aforementioned genetic mutations; however, they are fairly confident that factors such as:
- Excessive exposure to sunlight . The UV rays of the sun favor the appearance of any skin cancer, including Bowen's disease;
- Excessive exposure to tanning lamps . The tanning lamps give off the same UV rays as the sun, therefore they represent how much exposure to them is a factor favoring Bowen's disease and skin cancers in general;
- Light skin . Anyone can get Bowen's disease; however, statistics show that people with fair skin have a predisposition to develop the aforementioned tumor (and skin cancers in general).
The predisposition to Bowen's disease and skin cancers in general by people with fair skin is explained by the lower quantity of melanin in the skin, ie the pigment that protects the skin from the UV rays of the sun;
- Infections supported by the human papilloma virus (or HPV ). Human papilloma virus is a fairly common virus, notoriously associated with cervical cancer and penile cancer;
- The presence of a weak immune system ( immunodeficiency status or immunodepression ). The human immune system is what protects the body from infections and other threats from the external or internal environment. Therefore, when this protection system loses its effectiveness, the probability of developing various types of pathological conditions increases, including Bowen's disease and skin cancers in general.
The presence of a weak immune system is usually a problem of: those who take immunosuppressive drugs (they are drugs that lower the immune system), the elderly (for physiological reasons) and people suffering from diseases that cause immunodepression (eg, AIDS patients );
- Exposure to certain chemicals . Surveys have shown that a substance such as arsenic, for example, would favor the onset of Bowen's disease and other similar skin cancers.
Epidemiology
Currently, precise data on the incidence of Bowen's disease within the general population are lacking.
The only certainty of an epidemiological nature concerns the people most affected by Bowen's disease: those aged 60-70 years .
Symptoms and Complications
Bowen's disease manifests as a skin patch with the following possible characteristics:
- Red or brown color;
- Scaly appearance;
- Aspect of flat or raised spot;
- Similarity to a wart;
- Itchy spots, sore and / or easy to bleed, if exposed to insults such as scratching;
- Size that does not exceed a few centimeters.
The patch of skin that distinguishes Bowen's disease is persistent, ie it never heals spontaneously.
Locations of Bowen's Disease
Bowen's disease can occur anywhere in the human body; however, the statistics show that it appears more frequently in the skin areas most exposed to the sun, ie: face, neck, lower part of the lower limbs ( legs ) and forearms .
Curiosity
After the areas most exposed to the sun, the parts of the body most affected by Bowen's disease are the groin and genitals (vulvar area, in women, and penis, in men).
Complications of Bowen's Disease
As previously stated, if not treated properly or neglected, Bowen's disease can develop into a malignant tumor of the skin proper, called squamous carcinoma.
As it is capable of disseminating its own tumor cells ( metastases ) in the near and far lymph nodes, and in vital organs such as the liver and the brain, squamous carcinoma is a very dangerous condition and leads to death in the absence of appropriate and timely therapies.
How to understand when Bowen's disease has become a squamous carcinoma?
Typically, the transformation of Bowen's disease into a squamous cell carcinoma is marked by some special events, which could be:
- Bleeding in the absence of insults;
- The evolution of the skin patch in a red nodule with a rigid consistency;
- The evolution of the skin patch in an open sore or in an actual ulcer.
Upon the occurrence of the aforementioned events, it is extremely important to contact your doctor immediately and follow his instructions on what to do.
An early diagnosed squamous cell carcinoma is treatable with an excellent success rate .
Diagnosis
For the diagnosis of Bowen's disease, a physical examination, a history and a tissue biopsy of the area of the skin affected by the abnormal patch are fundamental.
Objective examination and medical history
The objective examination involves the careful observation of the anomalous patch and serves to delineate the characteristics; the anamnesis, on the other hand, consists of an investigation into the patient's state of health and his habits, and serves to establish whether the conditions exist for the onset of a skin cancer such as Bowen's disease.
Did you know that ...
The doctor who deals with the diagnosis of Bowen's disease and skin diseases in general is the dermatologist.
Tissue Biopsy
Tissue biopsy is the only diagnostic test that can establish the true nature of the abnormal patch on the skin.
Tissue biopsy involves the taking, directly from the suspected skin area, of a small piece of tissue and the observation of this tissue under a microscope; to the instrument, any tumor cells present have an unmistakable appearance.
Did you know that ...
Tissue biopsy allows Bowen's disease to be distinguished from other skin cancers responsible for a similar cutaneous sign.
Therefore, it is a fundamental test to make sure that a suspected Bowen's disease is not in fact a much more serious malignant neoplasm of the skin.
Therapy
Bowen's disease requires a therapy aimed at the complete removal of the skin patch (this patch is nothing but a set of cells with tumor characteristics).
Currently, to eliminate Bowen's disease there are several therapeutic techniques, the application of which is not accidental but depends on the location, size and appearance of the characteristic skin sign of the present condition.
Going into more detail, among the therapeutic techniques in question, are:
- Cutaneous curettage combined with electrocautery . Skin curettage is a work of scraping the skin, carried out with a special tool, in order to eliminate an area of unwanted skin; electrocautery, on the other hand, is a medical technique that serves to block possible bleeding, after operations such as the aforementioned curettage.
Cutaneous curettage combined with electrocautery is ideal when the skin patch due to Bowen's disease is small;
- Photodynamic therapy . It involves the combined use of a photosensitizing drug for topical use, to make the tumor area sensitive to light, and a source of luminous radiation, to kill hyper-photosensitive neoplastic cells (made such by the aforementioned drug).
Photodynamic therapy lends itself very well to treating cases of Bowen's disease, in which the skin patch is very wide;
- Cryotherapy (or cold therapy ). It consists in applying liquid nitrogen on the area of extension of the skin patch; liquid nitrogen has the power to freeze cancer cells and cause death;
- Classical surgical excision (or excision ). It is the removal by surgical incision of the tumor area present on the skin. The major drawback of this therapeutic option consists in the possibility of forming a noticeable skin scar, especially in the most delicate areas of the human body (eg: face);
- Topical chemotherapy drugs (or chemotherapeutic cream ). Chemotherapy drugs are special drugs, capable of killing rapidly growing cells, such as tumor cells.
Topical chemotherapy drugs are drugs designed to be applied to an area of skin affected by a tumor, in order to destroy the cells making up the latter.
Among the topical chemotherapy drugs most commonly used to treat Bowen's disease are those based on 5-fluorouracil;
- Immunotherapies for topical use (or immunotherapies in cream ). Intended for application to the tumor area, the immunotherapies in cream used in the presence of Bowen's disease are drugs that activate the immune response, in order to eliminate tumor cells.
The immunotherapeutic drug of choice for the treatment of Bowen's disease is the imitetine in cream;
- Radiotherapy . It involves the use of a source of high-energy X-rays, which, projected onto the tumor area, kill the neoplastic cells. It is not always effective, as relapses may occur;
- Laser therapy . It consists in exposing the skin to an intense beam of bright light, which has the power to vaporize the tumor, without excessively damaging the adjacent healthy areas and without causing excessive loss of blood.
Laser therapy is indicated when Bowen's disease has affected the fingers or genitals.
What happens after Bowen's Disease Treatment?
After the treatment of Bowen's disease, regardless of the therapeutic option adopted, the patient must undergo a series of periodic checks, in order to monitor how the recovery proceeds .
These periodic checks are very important, because they allow the attending physician to notice in time if the therapy has been effective or if instead there is need for a further therapeutic intervention.
Prognosis
If the diagnosis and treatment are timely, Bowen's disease is a condition with a generally benign prognosis, as it responds very well to currently available treatments.
Prevention
Bowen's disease is a form of cancer for which multiple prevention measures exist ; in detail, these prevention measures consist of:
- Avoid exposing yourself too much to the sun in the central hours of the hottest days;
- Use sunscreen, especially in the presence of light skin;
- Cover the parts of the body that are usually most exposed to sunlight and wear sunglasses;
- Do not abuse or, even better, do not use tanning lamps;
- Periodically check the skin for abnormal spots;
- Do not neglect any skin abnormality that appears suddenly and for no apparent reason;
- Undergo periodic dermatological checks, in the presence of a past history of Bowen's disease or other skin cancers.
