Bowen’s disease is known as the squamous cell carcinoma-in-situ. It is the pre-invasive form of squamous cell skin cancer. Cancer cells are present in this form of disease. These cells are present on the epidermis which is the outermost layer of the skin. Though cancer cells at this stage do not spread to lymph node but they spread through the skin surface. If Bowen’s disease is not treated right time, it spread to deeper layers of the skin. It can affect any part of the skin but is most common in trunks, arms or legs.
The word, in situ attached at end, indicates that this is the surface form of the skin cancer. Invasive squamous cell carcinomas are kind of cancer that grow inwards and can spread to inner layers. It is called Bowen’s disease after the name of the doctor who described it.
Patient suffering from Bowen’s disease, usually, has red and scaly patches. Shape of these patches are irregular but can be distinguished from surrounding tissue. There is no sensation in most of the patches but some may itch, ooze or crust. These patches are generally noticed on areas, exposed to sun for longer. In severe cases skin becomes sore and bleeds.
Sometimes because of nature of its patches on the skin, Bowen’s disease is misdiagnosed as eczema, psoriasis or fungus. Some its brown patches give suspicion of keratosis or melanoma. Skin biopsy is very important to diagnose Bowen’s disease to distinguish it from other skin disorders.
Bowen’s diseases is a form of skin cancer and like other forms of skin cancer, its genesis is also attributed to the sun exposure and aging. There are other causes for occurrence of Bowen’s disease which are unique to it.
Cervical Cancer causing wart virus is known to be the infecting microorganism in the SCC. Two persons may have had same amount of exposure to sun but only one person gets skin cancer due to presence of this virus. Arsenic is the other factor which can cause Bowen’s Disease; Arsenic is a poison. Arsenic contaminated some old water wells and also used in many elixirs, years ago. Mild arsenic poisoning may not cause the death of the person but it may lead to skin cancers or internal cancers. Immunosuppressant, Chronic skin injury and Dermatoses are other causes.
Surgical excision is the most common and the simplest treatment procedure for smaller SCC in Situ. During this procedure, tissues up to ¼th of an inch beyond the edge of cancer patch are also removed. Doctor may remove larger patches also from this technique but Mohs surgery is the most successful option and has the highest rate of cure.
There are other methods of treatment also, besides surgery. There are many methods to burn off the SCC in Situ. These treatments are “curettage and electrodessication”, laser destruction and liquid nitrogen cryotherapy.
Patients with multiple sites of SCC in situ or persons who do not want go through surgery or are not the candidates for surgery, X-ray or grenz ray radiation are administered. Efudex cream is recommended for application for 1 to 3 months period. There is other cream called Aldara which is recommended for 2 to 3 months.
Another treatment is called PDT that is photodynamic therapy but this is relatively newer therapy which is not so common in use. It is used as alternative to burn off SCC in situ. A drug is applied on the wound which gets absorbed by the cancer cells. After that a bright light is focused over the wound which makes the release of toxins and destroy the tumor.
Person who has had Bowen’s disease is also prone to other forms of skin cancers. The patient should regularly visit dermatologist for regular skin examination. Patches caused by Bowen’s disease increase gradually over the time period and can increase to several inches. It is noticed that if not treated on time, 5% cases of Bowen’s disease turns into invasive squamous cell carcinoma. It is best to avoid sun exposure to the skin to prevent any kind of skin cancer.
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