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Definition

Bowen's Disease is characterized by a precancerous, slow growing skin malignancy. The major symptom is a red-brown, scaly or crusted patch on the skin which resembles psoriasis or dermatitis. It may occur on any part of the skin or in the mucous membranes. Bowen's disease is most common in sun-exposed areas but may arise at any location. The lesion can be solitary or multiple. Bowen's disease is most common in sun-exposed areas but may arise at any location. The lesion can be solitary or multiple. Bowen’s disease is most often seen in people in their 60s and 70s, and is about three times more common in women than men.  The commonest site is the lower leg, mainly in women. About a fifth of women with it have more than one patch.

Causes

A skin disease marked by scaly or thickened patches on the skin and often caused by prolonged exposure to arsenic. The patches often occur on sun-exposed areas of the skin and in older, white men. The wart virus that causes cervical cancer (HPV 16) is often found to be infecting SCC in situ. It is thought that infection with this virus is one of the reasons why two people may have the same amount of sun damage, but only one keeps getting skin cancers. The other factor that causes SCC in situ is arsenic, the same poison made famous by the play "Arsenic and Old Lace" and the Russian villain Rasputin.

Symptoms

The symptoms of Bowen's disease include:

  • plaque located on or within the skin (intraepidermal)
  • open sore that bleeds and crusts and persists for weeks
  • wart-like growth that crusts and occasionally bleeds
  • persistent, scaly red patch with irregular borders that sometimes crusts or bleeds
  • pinkish or brownish raised areas of skin

Treatment

Radiotherapy treats Bowen’s disease by using high- energy x-rays which destroy the abnormal cells while doing as little harm as possible to normal cells. It works well for Bowen’s disease and may be useful in areas where surgery might be difficult or disfiguring.

In some cases a cream known as 5-fluorouracil (Efudix cream) may be used.  Photodynamic therapy is available in some clinics now: radiotherapy (X-ray treatment) is being used less often.

Photodynamic therapy is a new form of treatment.  A chemical is applied to the skin that makes the cells in the patch of Bowen’s disease sensitive to particular wavelengths of light.

Curettage the lesion is scraped off the skin. It may also be used with cauterisation, where the skin is lightly burnt with and electric current. Recurrence is slightly more likely than with surgery.

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