Reddish-brown and scaly skin changes can indicate Bowen’s disease, an early form of squamous cell carcinoma. How do you recognize Bowen’s disease and why is early diagnosis and treatment of precancerous disease important?
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One of the most common types of cancer in Germany is skin cancer, mostly basal cell carcinoma, Melanoma or squamous cell carcinoma (spinalioma). The latter also includes Bowen’s disease, an early form of carcinoma that can occur anywhere on the body. It is therefore referred to as 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 skin (epidermis), in which the underlying skin layers are not yet affected. As a carcinoma in situ, Bowen’s disease is not invasive, so it does not form metastases. The following synonyms are also used for the disease: Bowen’s carcinoma, Bowen’s skin cancer, dermatosis praecancerosa Bowen or dyskeratosis maligna. If the precancerous stage forms on the mucous membrane, it is called erythroplasia queyrata.
Causes of Bowen’s disease
One of the most important factors associated with the development of squamous cell carcinoma UV radiation. People who spend a lot of time in the sun, especially without adequate sun protection, have a higher risk of Bowen’s disease. In addition, contact with carcinogenic chemicals or the use of immunosuppressants can promote changes in the skin. Infection with human papillomavirus (HPV) can lead to Bowen’s carcinoma.
What are the symptoms of Bowen’s carcinoma?
If Bowen’s disease develops, small, irregularly shaped skin lesions develop that are reddish-brown in color and have sharp borders. The skin is scaly or crusted on the affected areas. Unlike the psoriasis (Psoriasis) often only a single focus of skin changes occurs in Bowen’s disease, and the typical one is also missing itching.
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 in the mouth and in the genital area. Erythroplasia Queyrat on mucous membranes grows faster and is more aggressive than Bowen’s carcinoma on the skin. Anyone who notices skin changes on the glans, foreskin or vulva should therefore seek medical advice. 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, visual diagnosis of conspicuous skin changes provides the first indications of Bowen’s disease. The skin changes caused by Bowen’s carcinoma are reminiscent of psoriasis, actinic keratosis, a nummular eczema (inflammatory, non-infectious skin disease) or a skin fungus infection. Therefore, the exclusion of other skin diseases (differential diagnosis) plays an important role. For a reliable diagnosis, a Biopsy carried out. For this purpose, a tissue sample is taken and examined histopathologically in the laboratory: the tissue is stained and examined under the microscope for typical cell changes.
Treatment of Bowen’s carcinoma
The aim is to remove the tumor as early as possible, as it can develop into malignant skin cancer if left untreated. Metastasis is then 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, the removal can be done on an outpatient basis, the patient only receives a local anaesthetic. The healing process after the procedure usually takes only a few days to a few weeks. During this time, sports should be avoided if possible. The treating dermatologist can provide precise information.
Therapies for Bowen’s disease:
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Thermokauter: Tumor is scraped out with a hot electric needle
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excision: Skin lesion is surgically excised
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Laser therapy: With a high-precision laser, the altered cells are destroyed and broken down by the body
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Cryotherapy: Extreme cold or targeted freezing kills the degenerated skin cells
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Photodynamic Therapy: A light-sensitive agent (photosensitizer) is applied to the skin and then irradiated with light
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Chemotherapy: They are applied locally and kill the 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 protection from UV radiation:
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Stay in the shade as much as possible and avoid direct sunlight during extended sunbathing.
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The sun is at its strongest between 11 a.m. and 3 p.m. – it is better to stay in the shade or indoors during this time.
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Long-sleeved clothing, long pants, and headgear such as hats can protect skin from UV radiation. Also at To swim it is advisable to cover the upper body with a t-shirt.
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When staying outdoors and sunbathing, sunscreen with a sufficiently high sun protection factor (SPF) should be applied. Renew this protective layer regularly, especially after swimming or when you sweat a lot.
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Especially 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, everyone over the age of 35 who has statutory health insurance is entitled to a biennial screening test for skin cancer. Some health insurance companies also offer skin cancer screening to younger insured persons or more often than every two years. Vaccination can also protect against the risk factor HPV.
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