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Bowen’s disease is a pre-invasive form of skin cancer (ca in situ) that affects one tissue of the skin without exceeding it. It is an intra-epidermal squamous cell carcinoma, located most often on the lower extremities, less often in the genital and perianal areas as well as sub- and periungual areas.
What is Bowen’s disease?
Bowen’s disease is a form of pre-invasive skin cancer (the so-called in situ form). In other words, cancer cells are confined to the skin tissue without exceeding it. Bowen’s disease is a squamous cell carcinoma that can turn into an invasive tumor, but only in 3%. The disease usually occurs in people over 60 years of age (more often women) and is located on the lower limbs in the periungual or genital area. Queyrat erythroplasia is a type of Bowen’s disease that develops in the area of the mucous membranes of the genital organs.
Bowen’s disease – causes
The following factors are responsible for getting Bowen’s disease:
- oncogenic HPV 16 and 18 (human papilloma infection),
- immunosuppression,
- chemical carcinogens (arsenic) – long-term exposure to this carcinogen,
- solar and ionizing radiation,
- mechanical irritation,
- chronic skin diseases.
The pre-invasiveness of neoplasms is due to its limited action – the cancer only occupies the underlying tissue and does not occupy the adjacent tissues.
Referring to the HPV virus (16,18, 90), it is worth mentioning that the formation of Bowen’s disease as a result of infection concerns the genital organs. During virological examination, the presence of HPV is revealed in practically XNUMX% of patients with lesions on the genital organs. The presence of neoplastic changes on the skin (e.g. on the fingers of the hand) is also related to the viral origin, which in turn may be a consequence of virus transmission from the genital area.
Symptoms of Bowen’s disease
A symptom of Bowen’s disease is the slowly enlarging, well-defined erythematous patches or discs with an irregular edge and peeling, sometimes crusted and eroded surface. The lesions are similar to eczema or psoriasis, usually single, multiple in about 10% of cases. Their color can be glaucous or reddish-brown, and the surface is shiny or smooth. The lesions are usually located on the skin or mucous membranes and have a different morphological picture. Usually the skin of the nape, torso, hands, fingers and auricles is affected.
Red-brown lesions may be slightly elevated above the level of healthy skin, i.e. they are characterized by a slight infiltration of the base. As the disease progresses, the infiltrates may enlarge and form irregular shapes. This results in the formation of erosions, which unfortunately leave scars. If there are ulcers in the area of the lesion – we may suspect that the cancer is transforming into an invasive tumor.
Queyrat erythroplasia, a type of Bowen’s disease, is characterized by the localization of lesions within the genital organs, and more specifically on their mucous membranes.
The diagnosis of Bowen’s disease
The diagnosis of Bowen’s disease takes into account:
- course of illness,
- nature of skin lesions,
- the result of a histopathological examination that allows you to assess the cells of the epidermis. It is the most important test in determining the diagnosis of a disease.
- the result of the dermatocopic examination,
- virological examination – to help reveal the presence of HPV.
During the diagnosis, it is important to exclude other diseases, because skin lesions of Bowen’s disease may also be confused with other ailments. Therefore, the presence of: long-term psoriasis, superficial basal cell carcinoma, as well as lichen pigmentary and atrophic lice should be eliminated.
In addition, Queyrat erythroplasia differentiates genital lesions that may be confused with:
- inflammatory lesions of the vulva in women,
- glans inflamed lesions in men.
The histopathological result is usually conclusive, but sometimes it may suggest the presence of other diseases, so it is important to differentiate Bowen’s disease from the following ailments:
- actinic keratosis,
- Paget’s disease,
- actinic keratosis,
- Darier disceratosis,
- Borst-Jadasson intraepithelial epithelium.
Bowen’s disease – prognosis
Adequately early diagnosis and treatment implementation guarantee a good prognosis. If the treatment is poorly chosen or not taken at all, the ailment may develop into an invasive form of squamous cell carcinoma (Bowen’s carcinoma). The risk of such a situation is estimated at about 3 percent. in the case of Bowen’s disease and about 10 percent. in the course of Queyrat erythroplasia. What symptoms indicate the transformation of the lesion into invasive cancer?
- increased infiltration of the base,
- significant growth of the lesion,
- the appearance of superficial ulcers.
Bowen’s disease – treatment
Bowen’s disease is treated depending on the lesion itself and on the general conditions: pharmacologically before administration of Fluorouracil (5-FU) and imiquimod and by using:
- cryotherapy, which involves the destruction of altered tissues by means of low temperatures (liquid nitrogen);
- curettage with electrocoagulation,
- laser vaporization (nail and genital area),
- excisions (Mohs microsurgery in the genital area),
- photodynamic therapy consisting in irradiating the changed parts of the skin (before the procedure, the patient should be given a photosensitizing agent),
- radiation therapy,
- ointments with imiquimod or 5-fluorouracil.
DIG. C-7. Bowen’s disease. A ring-shaped outbreak spreading circumferentially.
DIG. C-8. Bowen’s disease. Erythematous-papular focus with irregular edges.
DIG. C-9. Bowen’s disease. An erythematous-exfoliating focus with the presence of erosions and scabs.
Source: A. Kaszuba, Z. Adamski: “Lexicon of dermatology”; XNUMXst edition, Czelej Publishing House