Bowen’s Disease or Squamous Cell Carcinoma In Situ: Causes, Symptoms, Diagnosis, Treatment, Prevention

Bowen’s disease, also known as squamous cell carcinoma in situ, is an early form of skin cancer, which is characterized by red, scaly skin patches and can be mistaken for eczema, rash, psoriasis etc. Bowen’s disease occurs as a result of abnormal growth, division and accumulation of cells in the epidermis, which is the outer most layer of the skin. Bowen’s disease is an extremely early form of squamous cell skin cancer and is easily curable. Sometimes, in a minor percentage of patients with Bowen’s disease, the cancer can infiltrate into the deeper skin layers, and if not diagnosed and treated, it can metastasize to other parts of the body.

Treatment comprises of surgery, electrocautery, curettage, laser therapy, photodynamic therapy, topical creams, observation and sun protection.

The cause of Bowen’s disease or Squamous Cell Carcinoma In Situ is not clear. What is clear is that this disease is not hereditary, is not infectious and does not occur from allergy.

Risk Factors of Bowen’s Disease or Squamous Cell Carcinoma In Situ include:

• Prolonged sun exposure, especially in fair skinned individuals; however, it can also occur in those regions which have not been exposed to the sun.
• Previous treatment for a different cancer, such as radiation therapy.
• Exposure to engineering oils or arsenic can also cause Bowen’s disease; however, this is very rare.
• Individuals who take immunosuppressant medications are at a higher risk for Bowen’s disease.
• Sometimes, Bowen’s disease can also affect the genital regions and is commonly associated with the HPV (human papilloma virus).
• Individuals aged above 60 and especially women are at an increased risk for Bowen’s disease.

• Bowen’s disease or Squamous Cell Carcinoma In Situ can affect any part of the skin on the body; however, it commonly occurs on sun-exposed skin, such as hands, head and lower legs.
• Initially, there is appearance of red, scaly patches of around 1 to 3 cm in diameter.
• These patches can also appear as raised spots or warts.
• Patient has itchiness and the affected area can become sore.
• There can also be bleeding and scabbing.

Bowen’s disease or Squamous Cell Carcinoma In Situ can easily be diagnosed by its appearance to the naked eye. A skin biopsy, where a small sample of the skin is taken and sent to laboratory for testing, can be done for confirmation of diagnosis.

There are many different treatments available for Bowen’s disease or Squamous Cell Carcinoma In Situ. The type of treatment done depends on the location of the cancer on the body, its thickness, size and the number of patches. The manner and speed of healing of the skin is also taken into consideration. The skin present on the lower legs is more tight and fragile, especially in older individuals, so this may cause some problems with the healing.

• Surgery: The cancerous or abnormal skin is excised by the surgeon under local anesthesia. Patient may also need stitches. If the patches of Bowen’s disease or Squamous Cell Carcinoma In Situ are large, then surgery is not the best choice.
• Topical Therapy or Creams for Bowen’s Disease: Chemotherapy which is anti-cancer treatment/ cream which goes by the name of 5-fluorouracil can be used. Another topical cream known as Imiquimod works by using the body’s own immune system to destroy the abnormal cancerous cells. Both these creams are locally applied to the skin over a period of time. Both the creams, after their application, can cause redness and inflammation of the skin before an improvement in the Bowen’s disease or Squamous Cell Carcinoma In Situ is seen.
• Curettage & Electrocautery to Treat Bowen’s Disease: The cancerous region of the skin is curetted or scraped away under local anesthesia. Electricity or heat is employed to stop any bleeding. The treated area later on scabs over and heals in a few weeks. Scar formation may be there. This treatment is suitable for Bowen’s disease or Squamous Cell Carcinoma In Situ which has small patches.
• Cryotherapy for Treating Bowen’s Disease: Liquid nitrogen is used in this mode of treatment, which is sprayed onto the affected skin region in order to freeze it. Patient may feel very cold and the skin can remain uncomfortable for some days. The treated skin region can have blistering and oozing, after which there is scab formation which commonly falls off in a few weeks removing the affected skin region with it.
• Treating Bowen’s Disease Using Photodynamic Therapy or PDT: This mode of treatment is beneficial for patients with large areas of Bowen’s disease or Squamous Cell Carcinoma In Situ. In this treatment method, a light-sensitive cream is applied to the affected area of the skin. After 4 to 6 hours, a laser is then directed towards that skin region to kill the abnormal cells. The entire treatment session can last from 20 to 50 minutes. After this, a dressing is applied to cover the affected skin area for protection from light. Patient may need more than one session of PDT and it can be painful and can also cause inflammation; however, this resolves in a few days.
• Laser Therapy for Bowen’s Disease: Laser therapy comprises the use of intense light energy in order to remove the abnormal tissue. It is sometimes used for treating Bowen’s disease of fingers or genitals. This treatment is still under research to find out its effectiveness in the long run.

• Observation: Bowen’s disease or Squamous Cell Carcinoma In Situ tends to grow very slowly, often over a period of months to years. So, if a patient has a thin patch of affected skin area which is not changing and remains constant, then just simply observing it may be all that is needed. Regular check-ups with your dermatologist need to be undertaken for close monitoring of the affected region. This option is more suitable for those patients who may have trouble with skin healing after the treatment of Bowen’s disease.
• Sun Protection: Is very important; as if you have had a patch of Bowen’s disease or Squamous Cell Carcinoma In Situ then you are at an increased risk for getting a second patch. To prevent this, always use sun protection by wearing a hat, and using a sun block with a minimum SPF (sun protection factor ) of 30. Always avoid stepping out when the sun is at its harshest and wear clothes which cover your body, such as trousers, leggings and long skirts (women) to protect the legs.