Bowen disease

Bowen disease: Description, Causes and Risk Factors:Abbreviation: BD.Bowen disease is predominantly a disease of the elderly, with a mean age at diagnosis in the sixth decade. The disease is more common in men than woman. Bowen disease is most commonly reported in sun-exposed sites of whites. Bowen disease rarely occurs in patients with darker-pigmented skin.The exact cause of Bowen's disease is unknown. Like many forms of cancer, long-term sun exposure may be a cause.Other causes and risk factory may include:Chronic UV radiation: The age and sun-exposed body distribution of Bowen disease suggests the importance of chronic sun damage as a factor in the carcinogenesis of Bowen disease.
  • Arsenic exposure: The literature supports an association between Bowen disease and arsenic exposure, often occurring after a time lag of 10 years. The main sources of arsenic exposure include Fowler solution, a medication formerly used to treat psoriasis; Gay solution, a medication formerly used to treat asthma; contaminated well water; and certain pesticides.
  • Human papillomavirus: Human papillomavirus type 16 is by far the most common subtype isolated from lesions of Bowen disease, although other subtypes, such as HPV 2, 18, 31, 33, 54, 56, 61, 62, and 73 also have been found.
  • Immunosuppression: Immunosuppressed patients with Bowen disease are more likely to have multiple tumors and more aggressive tumors.
  • Other possible causes include genetic factors, trauma, other chemical carcinogens, and x-ray radiation.
In most cases, Bowen disease remains confined to the upper layer of the skin (epidermis). However, there is a small risk that the affected cells may migrate deeper into the skin layers. Once Bowen's disease escapes the epidermis, it can become a more aggressive form of skin cancer. If a patch of Bowen's disease becomes raised, tender or bleeding then it may have turned cancerous and will need medical attention.Bowen diseaseSymptoms:Flat, scaly, red and slightly raised red patches appear.A single patch or a number of patches may be present.
  • The edges of each patch are irregular but distinct from the surrounding skin.
  • The patch or patches grow very slowly.
  • The patches can affect any part of the body, but commonly occur on the lower leg.
  • Occasionally, the patches can be sore, irritated or bleed.
Diagnosis:The differential diagnosis includes superficial basal cell carcinoma, psoriasis and eczema, which can be differentiated histopathologically.Your doctor will check your skin and look at the size, shape, color, and texture of any suspicious areas.If skin cancer is a possibility, a piece of skin will be removed from the area and examined under a microscope to determine the nature of the cells involved.Treatment:There are several methods of treating Bowen disease. They may include:Cryotherapy: This type of treatment involves spraying of liquid nitrogen on the affected area. This is done mainly to freeze the affected area. Use of liquid nitrogen in has been found to be effective in ensuring quick recovery. This type of treatment is mainly used for small and flat lesions.Curettage (scraping the lesion off the skin, performed under local anaesthetic): This technique can be adopted to scarp away the area and use heat and electricity for stopping bleeding. Prior to this, a local anesthetic is given to the patient to numb the affected portion of the body.Topical therapy: A topical cream applied daily (usually for a period of at least 4 weeks) may be prescribed. This is a form of topical chemotherapy, which causes the abnormal skin cells to die (but not the normal healthy cells).Other treatments such as photodynamic therapy where abnormal cells are destroyed by a powerful light source following application of a cream that is taken up by the cells and laser are sometimes used but they are expensive, there is limited availability.Perform Mohs micrographic surgery on large or recurrent lesions, or when it is vital that tissue be spared. This technique removes skin cancers with minimal loss of healthy tissue by taking thin layers only in areas of the known tumor. Virtually all of the tissue margin is examined by frozen section. Mohs micrographic surgery has the highest cure rate for Bowen's disease.Disclaimer: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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