Bowen’s Disease

The exact causes of Bowen’s disease usually cannot be traced back to one single trigger. In most cases, several factors work together and increase the risk. The underlying cause is often long-term damage to the skin. This damage can change keratinocytes and disturb their normal growth control. Because these processes usually develop over many years, Bowen’s disease mainly occurs in older age.

Important known risk factors include:

• Chronic UV radiation and long-term sun exposure
• Artificial UV radiation, such as tanning beds
• Older age
• Fair skin type
• Immunosuppression, for example during immunosuppressive treatment
• Infections with human papillomaviruses
• Earlier arsenic exposure
• Existing actinic keratoses or other forms of non-melanoma skin cancer

Chronic sun damage plays an especially important role in the development of Bowen’s disease. UV exposure can cause mutations and changes in cellular repair mechanisms. Over time, this may support the development of malignant skin changes. Areas that are often exposed to light, such as the face, scalp or hands, are commonly affected.

A link with human papillomaviruses has also been described. This is especially relevant when Bowen’s disease occurs in the genital or anal area. High-risk types 16 and 18 may contribute to tissue changes.

Because Bowen’s disease is considered a precursor to squamous cell carcinoma, unusual or long-lasting skin changes should be checked early. Early diagnosis can improve treatment options and help limit the disease.

At first, Bowen’s disease develops slowly and often causes only unclear symptoms. It usually appears as a clearly defined, red and scaly skin change. It may be mistaken for eczema, psoriasis or chronic inflammation. Since Bowen’s disease is an early form of squamous cell carcinoma, early recognition of unusual skin changes is important.

The type of symptoms depends mainly on the size, location and duration of the skin change. In most cases, the condition remains unnoticed for a long time. It usually does not cause pain.

Typical symptoms or warning signs include:

• Clearly defined reddish skin change
• Dry, scaly or crusted surface
• Increase in size of the skin change
• Itching or burning
• Crusting
• Oozing or poorly healing skin areas
• Possible bleeding when irritated

One noticeable feature is that the skin change usually remains and slowly becomes larger. Bowen’s disease often appears on sun-exposed skin. However, it can occur on almost any part of the body.

Warning signs that may suggest progression to invasive squamous cell carcinoma include increasing hardness, nodule formation, ulcers or spontaneous bleeding. These signs should be checked by a doctor promptly. Because Bowen’s disease can look like other skin conditions, dermatological assessment and early diagnosis are especially important. This can improve treatment options and help prevent progression.

The diagnosis of Bowen’s disease usually starts with a dermatological examination of the affected skin area. Because Bowen’s disease often looks similar to chronic inflammatory skin diseases, careful assessment is important. It also helps with treatment planning and prognosis. A visual examination alone is not enough to confirm the diagnosis.

At the beginning, the affected skin area is examined carefully. The doctor looks at its size, borders, surface, color and structure. Dermoscopy is often used as well. This allows the skin structure to be viewed in more detail and suspicious changes to be assessed more accurately.

The final diagnosis is confirmed by a biopsy followed by histopathological examination of the tissue. This can show atypical keratinocytes that are limited to the epidermis. For Bowen’s disease, it is important that the basement membrane has not been broken through. This is the key difference between an early stage and invasive squamous cell carcinoma.

At the same time, other skin diseases with a similar appearance are ruled out. Bowen’s disease grows slowly and often causes only mild symptoms. For this reason, skin changes may be misinterpreted. Early dermatological examination is therefore important to classify the disease correctly.

Treatment of Bowen’s disease depends mainly on the size, location, extent and number of skin changes. The person’s general health also plays an important role in treatment planning. Since Bowen’s disease is an early form of non-melanoma skin cancer, the aim is to remove the atypical cells completely. Treatment should also prevent progression to invasive squamous cell carcinoma. If Bowen’s disease is detected and treated early, the prognosis is very good in most cases.

The most commonly used treatment approach is surgical removal of the affected skin area. In many cases, this can support complete healing. It also allows the removed tissue to be examined under a microscope. Surgical removal is often the treatment of choice for clearly defined skin changes.

Depending on the location and extent, other treatment options may also be considered. These include cryotherapy, where the affected skin area is frozen. Other options include photodynamic therapy, local medical treatments with immune-modulating creams and laser treatments. The choice of treatment also depends on the size of the lesion, cosmetic factors and functional needs.

An individual treatment plan is especially important for larger or multiple lesions. This also applies to difficult locations, such as the face. In these cases, both removal of the skin change and preservation of appearance and function are important.

Supportive and complementary treatment approaches may also be used. These include local hyperthermia. The aim of this method is to weaken cells through controlled heat and support the local immune response. The role of vitamin D, antioxidant substances and certain phytotherapeutic substances such as curcumin is also being studied. They may have antioxidant, inflammation-modulating or cell-protective properties. Good skin barrier care may also help stabilize chronically damaged skin. It can reduce local irritation during or after treatment.

Overall, the chances of successful treatment for Bowen’s disease are very good. At first, the changed cells are limited to the top layer of the skin. They can often be removed or treated completely. Without treatment, however, Bowen’s disease may develop into invasive non-melanoma skin cancer in the form of squamous cell carcinoma. Early treatment is therefore important. Regular follow-up checks are useful even after successful treatment. People with Bowen’s disease often also have other chronic sun damage or other forms of non-melanoma skin cancer.

The information listed contains relevant topics and serves to improve understanding.