Reddish-brown and scaly skin changes may indicate Bowen’s disease, an early form of squamous cell carcinoma. How is Bowen’s disease recognized and why is early detection and treatment of precancerous diseases important?
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One of the most common types of cancer in Germany is skin cancer, mainly basal cell carcinoma, melanoma or squamous cell carcinoma (squamous cell carcinoma). The latter also includes Bowen’s disease, an early form of cancer that can occur anywhere in the body. We therefore speak of a precancerous condition.
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What is Bowen’s disease?
Bowen’s disease is an early subtype of squamous cell carcinoma limited to the outermost layer of the skin (epidermis), in which the underlying skin layers are not yet affected. Being a carcinoma in situ, Bowen’s disease is non-invasive, so it does not metastasize. The following synonyms are also used for the disease: Bowen’s carcinoma, Bowen’s skin cancer, Bowen’s praecancerous dermatosis or malignant dyskeratosis. If the precancerous stage forms on the mucous membrane, it is referred to as queyrata erythroplasia.
Causes of Bowen’s disease
One of the most important factors associated with the development of squamous cell carcinoma is UV radiation. People who spend a lot of time in the sun, especially without adequate sun protection, have a higher risk of getting Bowen’s disease. Additionally, contact with cancer-causing chemicals or the use of immunosuppressants can promote changes in the skin. Human papillomavirus (HPV) infection can also lead to Bowen’s cancer.
What are the symptoms of Bowen’s cancer?
If Bowen’s disease develops, small, irregularly shaped skin lesions develop that are reddish-brown in color and have sharp edges. The skin is scaly or crusted on the affected areas. Contrary to psoriasis, Bowen’s disease often involves only a single focus of skin changes, and the typical itch is also absent.
Diagnosis of suspected Bowen’s disease
Squamous cell carcinoma can occur anywhere on the body, often affecting the face, trunk, hands, and lower legs. Bowen’s disease can also develop on the mucous membranes of the mouth and in the genital area. Queyrat erythroplasia on mucous membranes grows faster and is more aggressive than Bowen’s carcinoma on the skin. Anyone who notices skin changes on the glans penis, foreskin, or vulva should therefore see a doctor. In people with fair skin, the tumor often forms on parts of the body that are regularly exposed to the sun.
As with many other skin diseases, the visual diagnosis of conspicuous skin changes provides the first indications of Bowen’s disease. Skin changes caused by Bowen’s cancer are reminiscent of psoriasis, actinic keratosis, nummular eczema (inflammatory non-infectious skin disease), or a fungal infection of the skin. Therefore, the exclusion of other skin diseases (differential diagnosis) plays an important role. A biopsy is performed for a reliable diagnosis. For this purpose, a tissue sample is taken and histopathologically examined in the laboratory: the tissue is stained and examined under a microscope to identify typical cellular alterations.
Bowen’s cancer treatment
The goal is to remove the tumor as soon as possible, as if left untreated it can turn into malignant skin cancer. Metastasis is therefore also possible. If treated early, the prognosis is good.
Depending on the size and nature of the skin change, there are various treatments to choose from. As a rule, removal can be done on an outpatient basis, the patient receives only local anesthesia. The healing process after the procedure usually takes only a few days to a few weeks. During this period, if possible, sports should be avoided. The treating dermatologist can provide accurate information.
Bowen’s disease therapies:
Fireplace: The tumor is scraped with a hot electric needle
excision: The skin lesion is surgically removed
Laser therapy: With a high-precision laser, the altered cells are destroyed and broken down by the body
cryotherapy: Extreme cold or targeted freezing kills degenerated skin cells
Photodynamic therapy: A photosensitive agent (photosensitizer) is applied to the skin and then irradiated with light
Chemotherapy: They are applied topically and kill skin cells
Can Bowen’s disease be prevented?
One of the most important measures to prevent skin cancer in general and squamous cell carcinoma such as Bowen’s disease in particular is UV protection:
Stay in the shade as much as possible and avoid direct sunlight during long sunbathing.
The sun is strongest between 11am and 3pm – it is best to stay in the shade or indoors during this time.
Long-sleeved clothing, long pants, and headgear such as hats can protect the skin from UV rays. It is also recommended that you cover your upper body with a t-shirt while swimming.
When you are outdoors and sunbathing, you need to apply sunscreen with a sufficiently high sun protection factor (SPF). Regularly renew this protective layer, especially after swimming or when you sweat a lot.
In particular, protect babies and children from direct sun. Their skin is usually more sensitive than that of adults.
It is also advisable to have your skin checked regularly by a dermatologist. In Germany, all people over the age of 35 who have compulsory health insurance are entitled to a two-year skin cancer screening test. Some health insurance companies also offer skin cancer screening to policyholders younger or more often than every two years. Vaccination can also protect against HPV risk factor.
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